Association of clinic and ambulatory blood pressure with cardiovascular disease risk factors in individuals with type 2 diabetes mellitus

Open Access
- Author:
- Krecko, Laura Kraybill
- Area of Honors:
- Biobehavioral Health
- Degree:
- Bachelor of Science
- Document Type:
- Thesis
- Thesis Supervisors:
- Sheila Grace West, Thesis Supervisor
Dr. Lori Anne Francis, Thesis Honors Advisor - Keywords:
- blood pressure
cardiovascular disease
type 2 diabetes
ambulatory monitoring
dipping - Abstract:
- One of the most significant conditions associated with elevated cardiovascular disease (CVD) risk is type 2 diabetes mellitus. The present study measured blood pressure (BP) in healthy adults with type 2 diabetes both in clinic and with a 24-hour ambulatory monitor and assessed how these measurements correlated with established CVD risk factors. This study also classified participants based on degree of reduction in nighttime BP (known as “dipping”) and investigated cardio-metabolic differences between dippers and non-dippers. Correlations between clinic and ambulatory BP were highly consistent and significant across systolic blood pressure (SBP) (r = 0.57, p =<0.0001), diastolic blood pressure (DBP) (r=0.40, p=0.001) and mean arterial pressure (MAP) (r=0.37, p=0.003). However, neither BP measurement showed unique predictive utility in assessing CVD risk when separately examined against each CVD risk factor. Few statistically significant correlations were found between either type of BP measure and CVD risk factors, and those factors that were significantly correlated (AI, AI75, HOMA, and QUICKI) were similarly correlated with clinic and ambulatory measures. Participants who exhibited > 10% reduction in nighttime SBP (n=9) were characterized as dippers. Non-dippers (n=10) exhibited increased LDL, total cholesterol, triglycerides, and AI/AI75 compared to dippers. Although these differences were not statistically significant, retrospective power calculations provided estimates for feasible sample sizes necessary to make these differences significant in future studies. This study’s small sample size and highly-controlled procedure for obtaining clinic BP may explain similarities in correlations between clinic and ambulatory measurements and CVD risk factors. Overall, although this study showed no significant differences between clinic and ambulatory BP and their correlations to CVD risk factors in adults with type 2 diabetes, it did reveal different trends in cardio-metabolic profiles for dippers vs. non-dippers.