Impact of White-Coat Hypertension on Microvascular Complications in Type 2 Diabetes

Kramer, Caroline; Leitão, Cristiane Bauermann; Canani, Luís Henrique Santos; Gross, Jorge Luiz

doi:10.2337/dc08-1299

Cited by 40 publications

(18 citation statements)

References 25 publications

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“…The prevalence of 'white-coat' hypertension in other studies dealing with diabetic patients ranged between 14 and 51%. 16 Disparities between studies may be related to differences concerning sampling criteria and definition of 'white-coat' hypertension.…”

Section: Discussionmentioning

confidence: 99%

“…Whereas a 4-year follow-up study did not find worse outcomes within cases of 'white-coat' hypertension than in normotensive patients, 17 a cross-sectional analysis described diabetic patients with 'white-coat' hypertension as having an increased risk for diabetic retinopathy and nephropathy. 16 Differences between studies probably reflect that 'white-coat' hypertension confers lower dangers than sustained hypertension but higher risks than true normotension.…”

Section: Discussionmentioning

confidence: 99%

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Abnormalities in ambulatory blood pressure monitoring in hypertensive patients with diabetes

et al. 2011

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on behalf of the Spanish Society of Hypertension ABPM Registry investigators 9Our aim was to assess the ambulatory blood pressure monitoring (ABPM) characteristics or patterns in hypertensive patients with diabetes compared with non-diabetic hypertensives. We performed a cross-sectional analysis of a 68 045 patient database from the Spanish Society of Hypertension ABPM Registry, a nation-wide network of 41200 primary-care physicians performing ABPM under standardized conditions in daily practice. We identified 12 600 (18.5%) hypertensive patients with diabetes. When compared with patients without diabetes, diabetic hypertensives exhibited higher systolic blood pressure (BP) levels in every ABPM period (daytime 135.4 vs. 131.8, and nighttime 126.0 vs. 121.0 mm Hg, Po0.001 for both) despite they were receiving more antihypertensive drugs (mean number 1.71 vs. 1.23, Po0.001). Consequently, diabetic patients suffered from lack of control of BP more frequently than non-diabetic subjects particularly during the night (65.5% vs. 57.4%, Po0.001).Prevalence of a non-dipping BP profile (64.2% vs. 51.6%, Po0.001) was higher in diabetic patients. In the other hand, prevalence of 'white-coat' hypertension in diabetic patients was 33.0%. We conclude that there was a remarkably high prevalence of alterations in ABPM in patients with diabetes. Abnormalities in systolic BP, particularly during the night, and in circadian BP pattern could be linked with the excess of BP-related cardiovascular risk of diabetes. A wider use of ABPM in diabetic patients should be considered. Hypertension Research (2011) 34, 1185-1189; doi:10.1038/hr.2011.100; published online 11 August 2011Keywords: ambulatory blood pressure monitoring; circadian profile; diabetes; hypertension control INTRODUCTION Hypertension affects the majority of patients with diabetes and constitutes a major risk factor for vascular complications. 1 Ambulatory blood pressure monitoring (ABPM) provides a high-quality approach in estimating the true levels of blood pressure (BP). 2 Several population-and patient-based studies have showed the benefits of ABPM in exploring the relationship between BP and cardiovascular events. 2,3 A series of reports dealing with diabetic patients have also shown a close correlation between ambulatory BP and diabetic complications. 4,5 Evidences are available for the entire cardiorenal continuum of diabetic damage from the prediction of microalbuminuria by early changes in nocturnal BP in type 1 patients 6 to the effect of a riser pattern on mortality in patients with type 2 diabetes. 7 Nevertheless, information about the ABPM characteristics of large cohorts of diabetic hypertensives attending primary care centers is scarce. We aimed to assess such characteristics in comparison with non-diabetic hypertensives by using the Spanish Society of Hypertension ABPM Registry.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Abnormalities in ambulatory blood pressure monitoring in hypertensive patients with diabetes

et al. 2011

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“…Our results cannot be compared to these previous reports because we enrolled only type 2 diabetic patients with treated hypertension. A recent study 12 reported a greater prevalence of diabetic retinopathy and clinical nephropathy (macroalbuminuria) in type 2 diabetic patients with isolated office hypertension in comparison to sustained normotensives. Interestingly, we have recently reported 18 that the presence of microvascular complications is associated with increased aortic stiffness.…”

Section: Discussionmentioning

confidence: 99%

“…10 In normoalbuminuric type 2 diabetic patients, the prevalence of isolated office hypertension appears to be identical to hypertensive nondiabetic individuals, 11 and the presence of isolated office hypertension has been associated with macroalbuminuria and diabetic retinopathy. 12 However, less knowledge is available regarding the importance of uncontrolled isolated office hypertension (the white-coat effect) in treated hypertensives in relation to those with sustained controlled office and ambulatory hypertension.…”

Section: Introductionmentioning

confidence: 99%

Uncontrolled isolated office hypertension is associated with subclinical markers of cardiovascular disease in hypertensive type 2 diabetic patients

et al. 2010

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Isolated office hypertension (IOH) has been associated with structural cardiac abnormalities; however, its relation to worse cardiovascular prognosis remains uncertain. Less is known regarding the consequences of uncontrolled IOH in treated hypertensives. The aim was to investigate whether uncontrolled IOH was independently associated with two subclinical markers of cardiovascular disease, aortic stiffness and left ventricular hypertrophy (LVH). Clinical laboratory and 24-h ambulatory blood pressure (BP) data were obtained in 523 hypertensive patients with type 2 diabetes. Controlled office-ambulatory hypertension was defined by office blood pressure o140/90 mm Hg and 24-h BP o130/80 mm Hg, whereas uncontrolled IOH by office blood pressureX140/90 mm Hg and 24-h BP o130/80 mm Hg. Arterial stiffness was assessed by carotid-femoral pulse wave velocity (PWV) and left ventricular mass index (LVMI) by echocardiography. Statistics included multivariate linear and logistic regressions. According to BP patterns, 152 patients (29.1%) had controlled office-ambulatory hypertension, and 172 (32.9%) had uncontrolled IOH. Patients with uncontrolled IOH had greater LVMI (62.0 ± 21.9 vs. 52.9 ± 17.0 g m À2.7 , Po0.001) and PWV (11.5 ± 2.4 vs. 10.2 ± 2.1 m s À1 , Po0.001) than those with controlled hypertension. On linear model, after adjustment for several potential confounders, patients with uncontrolled IOH persisted with higher PWV (P¼0.003) and LVMI (P¼0.015). On logistic regression, the presence of uncontrolled IOH was independently associated with 2.7-fold (95% CI: 1.3-5.5) and 2.1-fold (95% CI: 1.1-4.0) higher risks of having increased aortic stiffness and LVH, respectively. In conclusion, uncontrolled IOH is associated with increased aortic stiffness and LVH in hypertensive type 2 diabetic patients. This may be a link to augmented cardiovascular risk. Keywords: aortic stiffness; left ventricular hypertrophy; type 2 diabetes; uncontrolled isolated office hypertension INTRODUCTION Some studies showed a better cardiovascular prognosis for isolated office hypertension patients (white-coat hypertension) than for those with sustained hypertension; 1-3 however, its prognostic significance in relation to sustained normal blood pressure (BP) remains controversial. 1,4-6 Nonetheless, isolated office hypertension has been associated with structural cardiac abnormalities in general population studies, mainly increased left ventricular mass, 7-9 which is a known marker of increased cardiovascular risk. 10 In normoalbuminuric type 2 diabetic patients, the prevalence of isolated office hypertension appears to be identical to hypertensive nondiabetic individuals, 11 and the presence of isolated office hypertension has been associated with macroalbuminuria and diabetic retinopathy. 12 However, less knowledge is available regarding the importance of uncontrolled isolated office hypertension (the white-coat effect) in treated hypertensives in relation to those with sustained controlled office and ambulatory hypertension.

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“…Diabetic nephropathy and diabetic retinopathy were more progressive in diabetic individuals with WCHT than in those with NT. 33 It would be useful for individuals with WCHT to undergo an OGTT to detect dysregulation of glucose metabolism in the early stages. Furthermore, early detection and prevention for progression from WCHT to SHT should be monitored by consecutive measurements of HBP.…”

Section: Discussionmentioning

confidence: 99%

Relationship of dysregulation of glucose metabolism with white-coat hypertension: the Ohasama study

et al. 2010

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Characteristics of glucose metabolism in subjects with white-coat hypertension (WCHT) have not been fully investigated. The purpose of this study was to determine the relationship between glucose metabolism and WCHT on the basis of blood pressure (BP) at home (HBP) in the general population. Participants were from Ohasama, a rural Japanese community, and included 466 residents (mean age, 61.0 years) who had no history of diabetes mellitus. HBP and oral glucose tolerance test values were measured. Participants were classified into four groups on the basis of their HBP and casual-screening BP (CBP) values: normotension (NT) (HBPo135/85 mm Hg, CBPo140/90 mm Hg); WCHT (HBPo135/85 mm Hg, CBPX140/90 mm Hg); masked hypertension (HBPX135/85 mm Hg, CBPo140/90 mm Hg); or sustained hypertension (SHT) (HBPX135/85 mm Hg, CBPX140/90 mm Hg). The relationships between glucose metabolism and BP among the four groups were examined using multivariate analysis adjusted for possible confounding factors. Factors in relation to glucose metabolism, such as fasting glucose level, 2-h postchallenge glucose level and homeostasis model assessment-insulin resistance index, were significantly higher in subjects with WCHT and SHT than in those with NT (all Po0.03). When men and women were analyzed separately, these relationships were more pronounced in women. Our results suggest that dysregulation of glucose metabolism in WCHT might contribute to the increase in the long-term cardiovascular risk among the general population.

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Impact of White-Coat Hypertension on Microvascular Complications in Type 2 Diabetes

Cited by 40 publications

References 25 publications

Abnormalities in ambulatory blood pressure monitoring in hypertensive patients with diabetes

Abnormalities in ambulatory blood pressure monitoring in hypertensive patients with diabetes

Uncontrolled isolated office hypertension is associated with subclinical markers of cardiovascular disease in hypertensive type 2 diabetic patients

Relationship of dysregulation of glucose metabolism with white-coat hypertension: the Ohasama study

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