Nocturnal hypertension and left ventricular diastolic dysfunction in diabetic patients with pre-heart failure phase: Prospective cohort HSCAA study

Background Diabetes is an important risk factor of heart failure (HF) and is associated with left ventricular (LV) diastolic dysfunction. However, integrated importance of diabetes and its comorbid conditions, such as altered nocturnal blood pressure (BP) variation, as predictors of diastolic dysfunction is not known in pre-HF period. The present study was conducted as longitudinal examination of the predictive value of nocturnal hypertension profiles on progression of LV diastolic dysfunction in diabetic and non-diabetic patients without heart diseases. Methods Pre-heart failure 422 subjects (154 diabetes, 268 non-diabetes) were followed for 36.8 ± 18.2 months. The relationships among the patterns of nocturnal hypertension and the outcome of LV diastolic dysfunction, defined as increase in E/e’ >14, were investigated in the patients with and without diabetes. Results The interaction effect of the diabetes status and the patterns of nocturnal hypertension on the hazard rate of the occurrence of E/e’>14 was statistically significant (p=0.017). Kaplan-Meier analysis results revealed that diabetic patients with non-dipper (p=0.016 vs. dipper) and riser (p=0.007 vs. dipper) had a significantly greater risk for a diastolic dysfunction event. Furthermore, multivariable Cox proportional hazards analysis revealed that non-dipper (HR: 3.00; 95% CI: 1.11–8.06, p = 0.029) and riser (HR: 3.58; 95% CI:1.24–10.35, p = 0.018) patterns were significantly associated with elevated risk of the outcome of LV diastolic dysfunction. In contrast, no similar significant associations were found in non-diabetic patients. Conclusions During pre-HF periods, nocturnal hypertension is an important predictor for progression of LV diastolic dysfunction in diabetic patients. Non-standard Abbreviation and Acronyms HSCAA: Hyogo Sleep Cardio-Autonomic Atherosclerosis ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement None ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The institutional ethical committee of Hyogo College of Medicine I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes No data on this paper has been published.