Pascal Delsart1, Madleen Lemaitre2, Anne Vambergue2, Sandro Ninni3, Christophe Bauters4, Guillaume Ledieu5, Diane-Flore Eymard5, Florence Baudoux2, Agathe Le Chevalier De Preville5, Jonathan Sobocinski6, David Montaigne3, Claire Mounier-Vehier7. 1. CHU Lille, Vascular Medicine and Hypertension Department, Institut Cœur Poumon, Boulevard Pr Leclercq, 59000, Lille, France. delsartpascal@yahoo.fr. 2. Endocrinology, Diabetology and Metabolism, CHU Lille, 59000, Lille, France. 3. Inserm U1011, CHU Lille, Institut Pasteur de Lille, EGID, Univ. Lille, 59000, Lille, France. 4. Inserm U1167, CHU Lille, Institut Pasteur, Univ. Lille, 59000, Lille, France. 5. CHU Lille, Vascular Medicine and Hypertension Department, Institut Cœur Poumon, Boulevard Pr Leclercq, 59000, Lille, France. 6. Inserm U1008, CHU Lille, 59000, Lille, France. 7. CHU Lille, University of Lille, 59000, Lille, France.
Abstract
AIMS: We assessed reverse dipping influence on the risk of lower limb events in type 2 diabetic patients without peripheral arterial disease. METHODS: Patients with type 2 diabetes addressed for cardiovascular risk stratification in our university hospital from 2008 to 2012 underwent 24 h blood pressure monitoring. Patients with a prior history of limb revascularization or with a stenosis > 50% of the legs were excluded. Reverse dipping was defined as a greater night-versus day-time systolic blood pressure. The endpoint was the first occurrence of lower limb revascularization or limb amputation. Hazard ratios (HRs) and 95% confidence intervals were calculated using the Cox model. RESULTS: Two hundred and eighty-one patients were included. During a median follow-up of 9.4 [7.7-10.6] years, 20 lower limb events and 45 all-cause deaths were observed. Thirty-five patients were reverse dippers. The reverse dipping status was associated with lower limb events when considering all-cause death as a competitive risk, (HR 3.61 [1.16-11.2], P = 0.026). Reverse dipping, HbA1C and proteinuria were independently associated with lower limb outcome in a multivariable analysis (respectively HR 4.09 [1.29-12.9], P = 0.017, HR 1.30 [1.04-1.63], P = 0.022 and HR 1.06 [1.02-1.11], P = 0.001). CONCLUSIONS: Reverse dipping status is independently associated with worse limb outcome in type 2 diabetic patients.
AIMS: We assessed reverse dipping influence on the risk of lower limb events in type 2 diabetic patients without peripheral arterial disease. METHODS: Patients with type 2 diabetes addressed for cardiovascular risk stratification in our university hospital from 2008 to 2012 underwent 24 h blood pressure monitoring. Patients with a prior history of limb revascularization or with a stenosis > 50% of the legs were excluded. Reverse dipping was defined as a greater night-versus day-time systolic blood pressure. The endpoint was the first occurrence of lower limb revascularization or limb amputation. Hazard ratios (HRs) and 95% confidence intervals were calculated using the Cox model. RESULTS: Two hundred and eighty-one patients were included. During a median follow-up of 9.4 [7.7-10.6] years, 20 lower limb events and 45 all-cause deaths were observed. Thirty-five patients were reverse dippers. The reverse dipping status was associated with lower limb events when considering all-cause death as a competitive risk, (HR 3.61 [1.16-11.2], P = 0.026). Reverse dipping, HbA1C and proteinuria were independently associated with lower limb outcome in a multivariable analysis (respectively HR 4.09 [1.29-12.9], P = 0.017, HR 1.30 [1.04-1.63], P = 0.022 and HR 1.06 [1.02-1.11], P = 0.001). CONCLUSIONS: Reverse dipping status is independently associated with worse limb outcome in type 2 diabetic patients.
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