Prevention for Micro- and Macro-Vascular Complications in Diabetic Patients

One of the goals in long-term cares for patients with diabetes mellitus (DM) is to prevent the development of micro-and macrovascular complications (The International Diabetes Federation, 2011). To achieve this purpose, an adequate control of blood pressure (BP) as well as a good glycaemic control is crucial (The International Diabetes Federation, 2011). The American Diabetes Association recommended that the BP goal should be lowered to 130/80 mmHg in the daytime of clinic setting (The American Diabetes Association, 20022011). However, in 4733 patients with type 2 DM at high risk for cardiovascular events followed the mean of 4.7 years, targeting a systolic casual/clinic BP (CBP) in the daytime of less than 120 mmHg as compared with less than 140 mmHg, did not reduce the rate of a composite outcome of fatal and nonfatal major cardiovascular events (ACCORD Study Group, 2010). Further, in 16,893 patient-years of follow-up at 862 sites in 14 countries, a tight control of systolic CBP in the daytime among patients with DM and cardiovascular disease to achieve systolic CBP in the daytime of less than 130 mmHg and diastolic CBP of less than 85 mmHg was not associated with improved cardiovascular outcomes compared with usual control (Cooper-DeHoff et al, 2010). At present, the reasons of difference are not clear. Recently, a discrepancy between screening BP by CBP measurment and ambulatory BP by ambulatory blood pressure monitaring (ABPM) has been noted. It has also been shown that in patients with essential hypertension, home BP (HBP) measurement in the morning has a stronger predictive power for mortality than CBP measurements in the daytime (Aihara et al, 1998, Ohkubo et al, 1998, Imai et al, 1999). Accordingly, the difference of results (ACCORD Study Group, 2010, Cooper-DeHoff et al, 2010) may be due to be not evaluated BP in the midnight or in the morning by ABPM or HBP measurements. To evaluate the usefulness of HBP measurement in the morning in patients with DM, we examined whether BP elevations at the awakening-up in the morning detected by HBP were more predictive than those in the daytime detected by CBP for microand macrovascular complications in patients with type 1 or 2 DM, as observed in patients with essential hypertension (Aihara et al, 1998, Ohkubo et al, 1998, Imai et al, 1999). Our cross-sectional studies have demonstrated that HBP measurements at the awakning-up in the morning offer stronger predictive power for microand macro-vascular complications