Non-dipping blood pressure pattern and new-onset diabetes in a 21-year follow-up

Figures & data

Table 1. Baseline characteristics and new-onset diabetes during 21-year follow-up.

	No diabetes n = 321	Diabetes n = 128	p Value
Age (year)	50.0 ± 5.7	49.7 ± 5.4	0.699
Female n (%)	168 (52.3)	60 (46.9)	0.296
Hypertensive n (%)	137 (42.7)	74 (57.8)	0.004
Antihypertensive medication n (%)	132 (41.1)	75 (58.6)	0.001
Beta blocker (%)	74 (23.1)	40 (31.3)	0.072
Calcium channel blocker (%)	22 (6.9)	17 (13.3)	0.029
ACE inhibitor (%)	47 (14.6)	35 (27.3)	0.002
Diuretic (%)	30 (9.3)	25 (19.5)	0.003
Smoking habit n (%)	146 (45.5)	72 (56.3)	0.039
Alcohol consumption (g/week)	18 (3–72)	36 (3–110)	0.142
BMI (kg/m^2)	26.3 ± 3.6	29.0 ± 5.1	<0.001
Clinic SBP (mmHg)	142 ± 20	151 ± 22	<0.001
Clinic DBP (mmHg)	87 ± 12	91 ± 11	0.002
Total cholesterol (mmol/L)	5.6 ± 0.9	5.8 ± 1.1	0.015
HDL cholesterol (mmol/L)	1.4 ± 0.4	1.3 ± 0.4	0.003
LDL cholesterol (mmol/L)	3.5 ± 0.8	3.6 ± 1.0	0.278
Triglycerides (mmol/L)	1.1 (0.9–1.5)	1.5 (1.1–2.2)	<0.001
Fasting glucose (mmol/L)	4.2 ± 0.3	4.7 ± 0.5	<0.001
Fasting insulin (mU/L)	8.8 (6.3–12.4)	12.9 (8.6–19.1)	<0.001
GGT (U/L)	24 (18–35)	34 (24–50)	<0.001
ALT (U/L)	23 (18–30)	29 (23–38)	<0.001
Creatinine (umol/L)	81 ± 14	83 ± 13	0.359
eGFR (CKD-EPI) mL/min	85 ± 14	85 ± 15	0.745
hsCRP	1125 (575–2191)	1517 (737–3239)	0.006
ABPM (mmHg)
24-h SBP	126 ± 12	132 ± 13	<0.001
daytime SBP	131 ± 13	136 ± 14	<0.001
nighttime SBP	113 ± 13	118 ± 14	<0.001
24-h DBP	80 ± 8	82 ± 9	0.015
daytime DBP	84 ± 8	86 ± 10	0.013
nighttime DBP	69 ± 9	71 ± 11	0.008
Non-dipper n (%)	65 (20.2)	37 (28.9)	0.048

BMI: body mass index; SPB: systolic blood pressure; DBP: diastolic blood pressure; hsCRP: high-sensitivity C-reactive protein; ABPM: ambulatory blood pressure measurement. Data are presented as prevalences or as mean ± SD for continuous variables, or as median (25th–75th) for skewed variables. Differences between groups were tested with ANOVA. For skewed variables, Mann-Whitney test was used.

Table 2. Baseline characteristics according to dipping status.

	Dipper – Dipper (1)	Non-dipper – Dipper (2)	Dipper – Non-dipper (3)	Non-dipper – Non-dipper (4)	p Value	post hoc
Number	148	19	199	83
Age (year)	48.7 ± 5	48.8 ± 5	50.4 ± 6	51.0 ± 5	0.006	a)* b)*
Female n (%)	85 (57.4)	8 (42.1)	91 (45.7)	44 (53.0)	0.145
Hypertensive n (%)	56 (37.4)	11 (57.9)	88 (44.2)	56 (67.5)	<0.001	b)*** c)**
Antihypertensive medication n (%)	52 (35.1)	10 (52.6)	89 (44.7)	56 (67.5)	<0.001	b)*** c)**
Beta blocker n (%)	33 (22.3)	6 (31.6)	46 (23.1)	29 (34.9)	0.129
Calcium channel blocker n (%)	7 (4.7)	3 (15.8)	14 (7.0)	15 (18.1)	0.003
ACE inhibitor n (%)	23 (15.5)	3 (15.8)	31 (15.6)	25 (30.1)	0.023
Diuretics n (%)	14 (9.5)	0	26 (13.1)	15 (18.1)	0.091
CHD n (%)	3 (2.0)	1 (5.3)	12 (6.0)	8 (9.6)	0.308
Metabolic syndrome n (%)	37 (25.0)	4 (21.1)	48 (24.1)	35 (42.2)	0.012	b)* d)*
Smoking habit n (%)	37 (25.0)	2 (10.5)	51 (25.6)	16 (19.3)	0.704
Alcohol consumption (g/week)	24 (3–72)	15 (0–72)	24 (3–78)	24 (1–144)	0.728
BMI (kg/m^2)	26.8 ± 4.0	26.3 ± 2.8	26.7 ± 4.1	28.6 ± 5.0	0.003	b)* c)**
Clinic SBP (mmHg)	141 ± 20	146 ± 18	145 ± 21	150 ± 22	0.009	b)**
Clinic DBP (mmHg)	86 ± 12	93 ± 9	88 ± 12	91 ± 12	0.002	b)**
Total cholesterol (mmol/L)	5.5 ± 0.9	5.3 ± 0.7	5.6 ± 1.0	5.9 ± 1.0	0.011	b)*
HDL cholesterol (mmol/L)	1.4 ± 0.4	1.4 ± 0.5	1.4 ± 0.4	1.3 ± 0.4	0.176
LDL cholesterol (mmol/L)	3.4 ± 0.9	3.3 ± 0.7	3.5 ± 0.9	3.7 ± 0.9	0.141
Triglycerides (mmol/L)	1.2 (0.9–1.5)	1.0 (0.8–1.1)	1.2 (1.0–1.8)	1.4 (0.7–3.4)	0.018	b)*** c)* d)*
Fasting glucose (mmol/L)	4.4 ± 0.4	4.2 ± 0.3	4.4 ± 0.5	4.4 ± 0.5	0.340
Fasting insulin (mU/L)	9.1 (6.4–13.3)	10.1 (5.9–12.3)	9.8 (6.6–13.8)	10.5 (7.3–19)	0.067
GGT (U/L)	23 (18–39)	24 (18–60)	28 (20–40)	32 (20–50)	0.070
ALT (U/L)	23 (19–31)	24 (16–30)	25 (20–33)	26 (18–36)	0.243
Creatinine (umol/L)	80 ± 14	86 ± 12	81 ± 13	85 ± 14	0.030	b)*
eGFR (CKD-EPI) mL/min	86 ± 13	82 ± 12	86 ± 15	81 ± 15	0.017	b)* c)*
hsCRP (ng/mL)	930 (545 –2058)	836 (307–1838)	1276 (708–1276)	1428 (749–3361)	0.022

CHD: coronary heart disease; BMI: body mass index; SBP: systolic blood pressure; DBP: diastolic blood pressure; HDL: high density lipoprotein; LDL: low density lipoprotein; GGT: gamma glutamyl transferase; ALT: alanine aminotransferase; eGFR: estimated glomerular filtration; CKD-EPI: Chronic Kidney Disease Epidemiologic Collaboration; hsCRP: high-sensitivity C-reactive protein. Data for continuous variables are means ± SD, tested with ANOVA (95 % confidence interval). Skewed variables are presented with median (25th–75th) percentiles and tested with Kruskal-Wallis test. Categorical variables are as prevalences (%) and tested with Pearson Chi-square or Fisher’s test. For post hoc analyses, *p < 0.05, **p < 0.01, ***p < 0.001, analyzed using ANOVA Tukey statistical test (95 % confidence interval) for differences between groups a) 1 vs. 3; b) 1 vs. 4; c) 3 vs. 4; d) 3 vs. 4.

Figure 1. Incidence of diabetes (%) according to dipping status. *p < 0.001 is for the Mantel-Haenszel linear-by-linear association.

Table 3. Binary logistic regression model on the new-onset diabetes in 21-year follow-up.

Covariates	OR	CI 95%	p Value
Dipping status
Dipping – Dipping	1		0.062
Non-dipping – Dipping	0.87	0.21–3.60	0.850
Dipping – Non-dipping	1.90	1.06–3.38	0.030
Non-dipping – Non-dipping	2.27	1.13–4.55	0.022
BMI (kg/m^2)
<25	1		0.244
25–30	1.10	0.62–1.94	0.748
>30	1.74	0.87–3.46	0.116
Fasting glucose (mmol/L)
<5.6	1
≥5.6	9.92	4.23–23.29	<0.001
Fasting triglycerides (mmol/L)
<1.7	1
≥1.7	1.77	1.03–3.06	0.041
Sex
Male	1
Female	0.70	0.41–1.19	0.191
Age	0.98	0.93–1.02	0.260
Smoking
Non-smoking	1
Smoking	1.47	0.87–2.46	0.147
Fasting insulin (mU/L)	1.04	1.00–1.08	0.027
24-h systolic mean ambulatory BP (mmHg)	1.02	1.00–1.04	0.026

OR: odds ratio; CI: confidence interval; BMI: body mass index. The cut points of fasting glucose and fasting triglycerides are defined according to the International Diabetes federation definition of the metabolic syndrome.

Table 4. Change in variables during the 20-year follow-up and dipping status.

	Dipping – Dipping (1) n = 148	Non-dipping – Dipping (2) n = 19	Dipping – Non-dipping (3) n = 199	Non-dipping – Non-dipping (4) n = 83	p Value	post hoc
BMI (kg/m^2)	1.4 ± 3.2	2.3 ± 2.3	2.1 ± 3.4	1.7 ± 3.3	0.216
Clinic SBP (mmHg)	−1 ± 25	−2 ± 22	−7 ± 28	−19 ± 26	<0.001	b)*** d)**
Clinic DBP (mmHg)	−12 ± 13	−15 ± 12	−16 ± 14	−21 ± 13	<0.001	a)* b)*** c)*
ABPM 24-h SBP	5 ± 16	−1 ± 13	4 ± 18	4 ± 17	0.455
ABPM 24-h DBP	−7 ± 10	−13 ± 9	−9 ± 10	−9 ± 9	0.081
Total cholesterol (mmol/L)	−0.6 ± 1.3	−0.7 ± 1.0	−0.9 ± 1.4	−1.2 ± 1.4	0.002	b)**
LDL (mmol/L)	−0.4 ± 1.2	−0.4 ± 0.9	−0.7 ± 1.2	−0.8 ± 1.2	0.039	b)*
HDL (mmol/L)	0.2 ± 0.3	0 ± 0.2	0.1 ± 0.3	0.1 ± 0.3	0.068
Fasting triglycerides (mmol/L)	−0 ± 0.6	0.1 ± 0.5	−0.1 ± 0.7	−0.3 ± 0.8	0.008	b)*
Fasting glucose (mmol/L)	1.6 ± 0.7	1.6 ± 1.0	1.7 ± 0.8	1.7 ± 0.9	0.752
Fasting insulin (mU/L)	2.5 ± 9.1	5.0 ± 6.8	4.9 ± 11.0	5.6 ± 17.0	0.162
Creatinine (µmol/L)	−11 ± 12	−12 ± 9	−8 ± 17	−7 ± 44	0.477
eGFR (mL/min)	−2 ± 12	−0 ± 9	−4 ± 13	−1 ± 16	0.199
Alat (U/L)	−1 ± 14	1 ± 13	−2 ± 18	−4 ± 16	0.417
GGT (U/L)	2 ± 59	−6 ± 31	−2 ± 27	−12 ± 70	0.210
Pack-years	3.5 ± 8.8	0.2 ± 0.6	3.2 ± 7.7	3.0 ± 7.00	0.379
Alcohol consumption (g/week)	−10 ± 62	24 ± 139	−15 ± 65	−17 ± 81	0.145

BMI: body mass index; SBP: systolic blood pressure; DBP: diastolic blood pressure; ABPM: ambulatory blood pressure measurement; LDL: low density lipoprotein; HDL: high density lipoprotein; eGFR: estimated glomerular filtration; CKD-EPI: Chronic Kidney Disease Epidemiologic Collaboration; ALT: alanine aminotransferase; GGT: gamma glutamyl transferase. For post hoc analyses, *p < 0.05, **p < 0.01, ***p < 0.001, analyzed using ANOVA Tukey statistical test (95 % confidence interval) for differences between groups a) 1 vs. 3; b) 1 vs. 4; c) 3 vs. 4; d) 3 vs. 4.