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Usefulness of ambulatory blood pressure monitoring in predicting the presence of autonomic neuropathy in type I diabetic patients

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Abstract

This study investigated whether nondipping (defined as a day–night change in blood pressure (BP) ⩽0%) could be assumed as a diagnostic index for autonomic neuropathy, and assessed its accuracy in discriminating between type I diabetic patients with and without autonomic neuropathy. In 87 type I diabetic patients with normal renal function (age 36±11, duration 17±9 years, serum creatinine 67.2±15.9 μmol/l), four cardiovascular tests and 24-h BP monitoring were performed, and the percentage day–night change (Δ) in systolic (SBP) and diastolic BP (DBP) was calculated. Sixteen patients had ΔSBP and/or ΔDBP ⩽0%. In a multiple logistic regression with adjustment for sex, age, and body mass index, the odds ratio for having autonomic neuropathy was seven times higher in patients with ΔSBP ⩽0% as opposed to those without (odds ratio 6.97, CI 1.4–34.9, P=0.018). Using Receiver Operating Characteristic (ROC) analysis, ΔBP showed an acceptable accuracy in discriminating between patients with and without autonomic neuropathy (area under the ROC curve 0.69±0.06 and 0.72±0.05 for ΔSBP and ΔDBP, respectively). Adequate cutoff values were 0% for ΔSBP (sensitivity, 26%; specificity, 95%; positive predictive value, 87%) and 5% for ΔDBP (sensitivity, 26%; specificity, 92%; positive predictive value, 81%). In type I diabetic patients with normal renal function, a value of ΔSBP ⩽0% identifies the presence of autonomic neuropathy with a very high chance. Nondipping at the cutoff proposed could be considered an adjunctive marker of autonomic neuropathy provided with a high specificity and low sensitivity.

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Authors and Affiliations

  1. Department of Internal Medicine, Endocrinology, Tor Vergata University, Rome, Italy

    V Spallone, M R Maiello, R Morganti, S Mandica & G Frajese

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  1. V Spallone
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  2. M R Maiello
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  3. R Morganti
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  4. S Mandica
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  5. G Frajese
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Correspondence to V Spallone.

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Spallone, V., Maiello, M., Morganti, R. et al. Usefulness of ambulatory blood pressure monitoring in predicting the presence of autonomic neuropathy in type I diabetic patients. J Hum Hypertens 21, 381–386 (2007). https://doi.org/10.1038/sj.jhh.1002162

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