medwireNews: Ambulatory blood pressure monitoring (ABPM) should be used in patients with type 1 diabetes, say researchers who found that almost a quarter had masked hypertension.
And these individuals had greater arterial stiffness than those with normal BP, which the team says is “a condition known to precede manifest hypertension and cardiovascular disease.”
Per-Henrik Groop (Helsinki University Hospital, Finland) and colleagues studied 140 type 1 diabetes patients from the FinnDiane cohort. They were aged an average of 43.7 years and half were men.
All the patients underwent 24-hour ABPM, revealing that 23% had masked hypertension, defined as 24-hour ABP of 130/80 mmHg or higher in combination with office BP below 140/90 mmHg.
These patients were more likely to be older and male, with a larger waist-to-hip ratio than the 38% of patients who had normal ABPM results. Notably, they had similar glycemic control, smoking history, and use of antihypertensive medication as the 33% of patients who had sustained hypertension (elevated office and ambulatory BP), as well as similar nephropathy status and prevalence of cardiovascular events.
The researchers note that 41% of the patients with masked hypertension were receiving antihypertensive medication at the time, with 19% taking two or more medications, indicating that their treatment was suboptimal.
This supports suggestions that many patients with masked hypertension in fact have sustained hypertension, because the focus of treatment on normalizing office BP creates masked hypertension, they say. Treated patients with masked hypertension had significantly greater BP variability than those who were untreated, and had poorer metabolic profiles and more evidence of nephropathy.
After accounting for multiple variables, the team found that patients with masked hypertension had significantly higher 24-hour pulse-wave velocity, a marker of arterial stiffness, compared with patients with normal ABP. The same was true for those with sustained hypertension and, notably, white-coat hypertension (elevated office but normal ambulatory BP), although the latter was found in only 6% of the patients.
“Therefore, detailed evaluation of BP patterns by ABPM could be clinically meaningful in order to improve the diagnosis and management of hypertension in this group,” write the researchers in Diabetologia.
They note that there is currently no consensus regarding the optimal cutoffs to define hypertension in type 1 diabetes patients, but add that recent recommendations from the American Heart Association and the ADA advise thresholds of 130/80 mmHg for office BP and 125/75 mmHg for 24-hour ABP. In the FinnDiane cohort, this would markedly reduce the prevalence of normotension, from 38% to 16%, while reducing that of masked hypertension from 23% to 17% and increasing the prevalence of sustained hypertension from 33% to 61%.
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