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No Deleterious Effects of Tight Blood Glucose Control on 24-Hour Ambulatory Blood Pressure in Normoalbuminuric Insulin-Dependent Diabetes Mellitus Patients

Medical Department M (Diabetes and Endocrinology), Aarhus Kommunehospital, DK 8000 Aarhus, Denmark

Address correspondence and requests for reprints to: Per Løgstrup Poulsen, Department of Medicine M (Diabetes and Endocrinology), Aarhus Kommunehospital, DK 8000 Aarhus C, Denmark. E-mail: Logstrup{at}dadlnet.dk

Intensive therapy aiming at near normalization of glucose levels effectively delays the onset and slows the progression of complications in insulin-dependent diabetes mellitus (IDDM) and is recommended in most patients. However, in a recent report, intensive insulin treatment was found to be associated with deleterious effects on nocturnal blood pressure (BP), the proposed mechanisms being subclinical nocturnal hypoglycemia or hyperinsulinemia. The aim of the present study was to evaluate the association between glycemic control, insulin dose, and 24-h ambulatory BP (AMBP) in a group of well-characterized IDDM patients.

Twenty-four-h AMBP was measured in 123 normoalbuminuric [urinary albumin excretion (UAE) < 20 µg/min] IDDM patients using an oscillometric technique (SpaceLabs 90207) with readings at 20-min intervals. UAE was measured by RIA and expressed as geometric mean of three overnight collections made within 1 week. Tobacco use and level of physical activity was assessed by questionnaire. HbA_1c was determined by high-pressure liquid chromatography (nondiabetic range, 4.4–6.4%), and patients were stratified into quartiles according to HbA_1c levels.

Mean HbA_1c values in the four groups were 7.0% (n = 31), 8.0% (n = 31), 8.6% (n = 31), and 9.7% (n = 30). The groups were comparable regarding age, gender, diabetes duration, body mass index, UAE, smoking status, and physical activity. AMBP levels were almost identical in the HbA_1c quartiles with night values of (increasing HbA_1c order): 110/63, 112/66, 112/66, and 113/65 mm Hg (P = 0.69/P = 0.32). There was no association between tight glucose control and higher nocturnal BP or a more blunted circadian BP variation. On the contrary, a weak positive correlation between night to day ratios of mean arterial BP and HbA_1c values was found (r = 0.26, P = 0.005), i.e. blunted circadian BP variation is most frequent in patients with high HbA_1c values. Neither did we find doses of insulin to be associated with night BP (r = 0.04, P = 0.68).

Tight blood glucose control is not associated with deleterious effects on 24-h AMBP in normoalbuminuric IDDM patients. Intensive therapy can be implemented without concerns of inducing high nocturnal BP and accelerating diabetic complications.