Forums » Open clinical » Diabetes » Masked hypertension in type 2 diabetes
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Masked hypertension in type 2 diabetes
posted at 22/2/2012 6:09 PM GMT
on bmj.com
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Posts: 142
First: 29/4/2011 Last: 14/5/2012 |
Masked Hypertension, Endothelial Dysfunction, and Arterial Stiffness in Type 2 Diabetes Mellitus: A Pilot Study Takeno K et al. – Given that patients with impaired flow–mediated dilatation (FMD) and higher brachial–ankle pulse wave velocity (baPWV) are known to be at higher risk of cardiovascular disease, the data suggest that type 2 diabetic patients with masked hypertension (MHT) could be also at increased risk of cardiovascular disease. Methods · The study subjects were patients with type 2 diabetes who were normotensive based on blood pressure (BP) measurement in the clinic (n = 80) without antihypertensive drugs and free of retinopathy, macroalbuminuria, overt cardiovascular disease. · Subjects underwent 24-h ambulatory blood pressure monitoring (ABPM), measurement of flow-mediated dilatation (FMD), and brachial-ankle pulse wave velocity (baPWV). · Based on the results of ABPM, subjects with mean daytime systolic BP ≥135 and/or 85 mm Hg were defined as MHT and their clinical data were compared with those of normotensive patients (NT). · The data were also compared with those of type 2 diabetic patients with hypertension (HT) as measured in the clinic (n = 32). Results · MHT was detected in 47.5% of the study subjects with normotension at clinic (n = 38). · Impaired FMD (5.65 ± 2.00% for NT, 4.26 ± 1.88% for MHT, 3.90 ± 1.71% for HT, P < 0.001) and higher baPWV (1,514.2 ± 212.7 cm/s for NT, 1,749.9 ± 339.7 cm/s for MHT, and 1,768.6 ± 302.8 cm/s for HT, P < 0.001) were similarly noted in patients with MHT and HT compared with NT. · Multivariate regression analysis indicated that daytime systolic BP measured by ABPM, the estimated duration of diabetes and serum triglycerides were significantly associated with FMD and daytime systolic BP measured by ABPM, not systolic BP at clinic, age, and HbA1c were significantly associated with baPWV. While a small study the results suggest that we may be missing a significant number of persons with type 2 diabetes who also have masked hypertension and significant cardiovascular risk
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Re: Masked hypertension in type 2 diabetes
posted at 22/2/2012 8:54 PM GMT
on bmj.com
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Posts: 367
First: 13/4/2011 Last: 16/5/2012 |
Hello Dr. Diabetes: Many thanks for providing this useful information to us. I will try to reach the full article. But I can tell you from my ABPM experience is that I frequently see patients, (diabetics and non-diabetics) that are normotensive during the daytime and are hypertensive when they sleep. These patients, probably would behave as normotensives in the medical office. All Best, Joey
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Re: Masked hypertension in type 2 diabetes
posted at 23/2/2012 2:10 PM GMT
on bmj.com
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Posts: 446
First: 17/6/2011 Last: 15/5/2012 |
I think this is a very difficult area and i'm not certain how we should manage this - Joey R waht do you do in your practice? There are a number of poeple who argue that we need hard outcome studies before we treat this. best sadian |
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Re: Masked hypertension in type 2 diabetes
posted at 23/2/2012 3:08 PM GMT
on bmj.com
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Posts: 142
First: 29/4/2011 Last: 14/5/2012 |
We really do not know yet about the prognosis or treatment of this subgroup of persons or even how common this phenomenum is. However, that treatment may be warranted us suggested by the observation that home self-monitoring of blood pressure results in improved outcomes when combined with prompt changes in pharmacothearpy. This was summarized in a systematic review a couple of years ago. Br J Gen Pract. 2010 Dec;60(581):e476-88. Self-monitoring and other non-pharmacological interventions to improve the management of hypertension in primary care: a systematic review.SourceNational University of Ireland, Galway, Ireland. AbstractBACKGROUND:Patients with high blood pressure (hypertension) in the community frequently fail to meet treatment goals: a condition labelled as 'uncontrolled' hypertension. The optimal way to organise and deliver care to hypertensive patients has not been clearly identified. AIM:To determine the effectiveness of interventions to improve control of blood pressure in patients with hypertension. DESIGN OF STUDY:Systematic review of randomised controlled trials. SETTING:Primary and ambulatory care. METHOD:Interventions were categorised as following: self-monitoring; educational interventions directed to the patient; educational interventions directed to the health professional; health professional- (nurse or pharmacist) led care; organisational interventions that aimed to improve the delivery of care; and appointment reminder systems. Outcomes assessed were mean systolic and diastolic blood pressure, control of blood pressure and proportion of patients followed up at clinic. RESULTS:Seventy-two RCTs met the inclusion criteria. The trials showed a wide variety of methodological quality. Self-monitoring was associated with net reductions in systolic blood pressure (weighted mean difference [WMD] -2.5 mmHg, 95%CI = -3.7 to -1.3 mmHg) and diastolic blood pressure (WMD -1.8 mmHg, 95%CI = -2.4 to -1.2 mmHg). An organised system of regular review allied to vigorous antihypertensive drug therapy was shown to reduce blood pressure and all-cause mortality in a single large randomised controlled trial. CONCLUSION:Antihypertensive drug therapy should be implemented by means of a vigorous stepped care approach when patients do not reach target blood pressure levels. Self-monitoring is a useful adjunct to care while reminder systems and nurse/pharmacist -led care require further evaluation. |
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Re: Masked hypertension in type 2 diabetes
posted at 24/2/2012 1:30 AM GMT
on bmj.com
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Posts: 367
First: 13/4/2011 Last: 16/5/2012 |
Hello Marquise de Sadian and Dr. Diabetes: I utilize the IDACO thresholds for diagnosing Nocturnal, Diurnal, and 24 hours ABPM levels of blood pressure in my reports. It is a 10 years follow-up study with a world-wide population followed-up with hard outcomes for about 10 years. I would suggest NICE to adopt this study. "Diagnostic Thresholds for Ambulatory Blood Pressure Monitoring Based on 10-Year Cardiovascular Risk." All Best, Joey
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