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Nocturnal Blood Pressure Elevation in Patients with Type 1 Diabetes Receiving Intensive Insulin Therapy Compared with that in Patients Receiving Conventional Insulin Therapy¹

Department of Internal Medicine, Divisions of Endocrinology (S.T.A.) and Nephrology (A.B.), American University Hospital-Medical Center and Chronic Care Center for Diabetes, New York, New York 10022

Address all correspondence and requests for reprints to: Sami T. Azar, M.D., F.A.C.P., Division of Endocrinology, American University Hospital, 850 3rd Avenue, 18th Floor, New York, New York 10022.

Studies have shown that type 1 diabetic patients may suffer from nocturnal elevation in blood pressure and that this elevation may be related to hyperinsulinemia. In this study we tested the hypothesis that tight type 1 diabetes control, which is usually accompanied by hyperinsulinemia and subclinical nocturnal hypoglycemia, may result in a higher rise in nocturnal blood pressure compared with conventional type 1 diabetes control. Eighteen patients treated with intensive insulin therapy (multiple daily injections; IIT) were compared with 18 patients treated with conventional insulin regimens (twice daily injections of regular and intermediate acting insulin; CIT). Both groups were matched for age, sex, duration of diabetes, body weight, body mass index, baseline daytime blood pressure, and microalbuminuria levels. Hemoglobin A_1c was lower in the IIT group compared with that in the CIT group (8.1 ± 1.2% vs. 11.0 ± 3.2%; P < 0.01). The amount of insulin/body weight (units per kg) was higher in the IIT group than that in the CIT group (1.0 ± 0.2 vs. 0.7 ± 0.2 U/kg; P < 0.05). In all patients, a 24-h ambulatory blood pressure was recorded. The nocturnal diastolic blood pressure was higher in the IIT group (66 ± 9 mm Hg) than in the CIT group (55 ± 4 mm Hg; P < 0.01). The nocturnal decline in both systolic and diastolic blood pressure was lower in the IIT group (7 ± 5 and 6 ± 4 mm Hg, respectively) compared with that in the CIT group (13 ± 6 and 16 ± 6 mm Hg, respectively; P < 0.01). The nocturnal heart rate was higher in IIT group than in the CIT group (81 ± 12 vs. 67 ± 9/min; P < 0.05). These findings show that the intensive insulin therapy regimen may have a more deleterious effect than the conventional insulin therapy regimen on the nocturnal blood pressure of patients with type 1 diabetes.

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