Masked nocturnal hypertension as a result of high prevalence of non-dippers among apparently well-controlled hypertensive patients with type 2 diabetes mellitus: data from a prospective study

Pop, Călin; Manea, Viorel; Luchiana, Pruna; Mihaela, Cosma; Lavinia, Pop

doi:10.1186/s13098-022-00899-6

Cited by 5 publications

(3 citation statements)

References 53 publications

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“…A further point should be made. MH may present different clinical patterns such as persistent out-of-office hypertension, isolated daytime, or isolated nocturnal hypertension [ 49 ]. Information on this issue, based on four of the studies included in the meta-analysis, revealed that MH patients (identified according to daytime BP criteria) had significantly higher nocturnal BP values than controls.…”

Section: Discussionmentioning

confidence: 99%

Masked Hypertension and Exaggerated Blood Pressure Response to Exercise: A Review and Meta-Analysis

et al. 2023

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Aim: Whether exaggerated blood pressure response (EBPR) to exercise represents a marker of masked hypertension (MH) in individuals with no prior history of hypertension is still unclear. We investigated this issue through a review and a meta-analysis of studies providing data on this association in normotensive individuals undergone both to dynamic or static exercise and to 24 h blood pressure monitoring (ABPM). Design: A systematic search was performed using Pub-Med, OVID, EMBASE, and Cochrane library databases from inception up to 31 December 2022. Studies were identified by using the following search terms: “masked hypertension”, “out-of-office hypertension”, “exercise blood pressure”, “exaggerated blood pressure exercise”, “exercise hypertension”. Results: Nine studies including a total of 387 participants with MH and 406 true normotensive controls were considered. Systolic BP (SBP) and diastolic BP (DBP) at rest were significantly higher in MH individuals than in sustained normotensives: 126.4 ± 1.4/78.5 ± 1.8 versus 124.0 ± 1.4/76.3 ± 1.3 mmHg (SMD: 0.21 ± 0.08, CI: 0.06–0.37, p = 0.007 for SBP; 0.24 ± 0.07, CI: 0.08–0.39, p = 0.002 for DBP). The same was true for BP values at peak exercise: 190.0 ± 9.5/96.8 ± 3.7 versus 173.3 ± 11.0/88.5 ± 1.8 mmHg (SMD 1.02 ± 0.32, CI: 0.39–1.65, p = 0.002 for SBP and 0.97 ± 0.25, CI: 0.47–1.96, p < 0.0001 for DBP). The likelihood of having an EBPR was significantly greater in MH than in their normotensive counterparts (OR: 3.33, CI: 1.83–6.03, p < 0.0001). Conclusions: Our meta-analysis suggests that EBPR reflects an increased risk of MH and that BP measurement during physical exercise aimed to assess cardiovascular health may unmask the presence of MH. This underscores the importance of BP measured in the medical setting at rest and in dynamic conditions in order to identify individuals at high cardiovascular risk due to unrecognized hypertension.

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Section: Discussionmentioning

confidence: 99%

Masked Hypertension and Exaggerated Blood Pressure Response to Exercise: A Review and Meta-Analysis

et al. 2023

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“…Short BP phenomena (morning BP peaks, BP variability and morning BP surge) have been shown to adversely affect the incidence of cardiovascular outcomes independent of 24-h mean BP values. Night-time BP has been identified as a more important predictor of cardiovascular events and mortality than daytime BP, and several studies have shown that an attenuation of the physiological nocturnal BP fall (non-dipping) [167][168][169], a nocturnal BP rise (reverse dipping) [170,171] or even an isolated nocturnal hypertension [172,173] are more common than previously thought. However, these notions cannot be translated into management recommendations because no randomized clinical trial has been carried out to demonstrate additional cardiovascular benefits of focusing treatment on the correction of a raised nocturnal BP, an excessive BP variability or a marked BP increase at arousal.…”

Section: Other Blood Pressure Measurement Modalitiesmentioning

confidence: 99%

Perspectives on improving blood pressure control to reduce the clinical and economic burden of hypertension

et al. 2023

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The clinical and economic burden of hypertension is high and continues to increase globally. Uncontrolled hypertension has severe but avoidable long‐term consequences, including cardiovascular diseases, which are among the most burdensome and most preventable conditions in Europe. Yet, despite clear guidelines on screening, diagnosis and management of hypertension, a large proportion of patients remain undiagnosed or undertreated. Low adherence and persistence are common, exacerbating the issue of poor blood pressure (BP) control. Although current guidelines provide clear direction, implementation is hampered by barriers at the patient‐, physician‐ and healthcare system levels. Underestimation of the impact of uncontrolled hypertension and limited health literacy lead to low adherence and persistence among patients, treatment inertia among physicians and a lack of decisive healthcare system action. Many options to improve BP control are available or under investigation. Patients would benefit from targeted health education, improved BP measurement, individualized treatment or simplified treatment regimens through single‐pill combinations. For physicians, increasing awareness of the burden of hypertension, as well as offering training on monitoring and optimal management and provision of the necessary time to collaboratively engage with patients would be useful. Healthcare systems should establish nationwide strategies for hypertension screening and management. Furthermore, there is an unmet need to implement more comprehensive BP measurements to optimize management. In conclusion, an integrative, patient‐focused, multimodal multidisciplinary approach to the management of hypertension by clinicians, payers and policymakers, involving patients, is required to achieve long‐term improvements in population health and cost‐efficiency for healthcare systems.

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“…Using ambulatory blood pressure monitoring with a Holter device, we can identify the non-dipping or reverse-dipping blood pressure profiles. A decrease in blood pressure from day to night of <10% identifies non-dipping and, respectively, reverse dipping [ 14 ]. Nondipping is more common in diabetic patients (39-62%) than in the general population, while reverse dipping is present in 9-30%.…”

Section: Introductionmentioning

confidence: 99%

The Importance of Evaluating Sudomotor Function in the Diagnosis of Cardiac Autonomic Neuropathy

Nica,

Rusu,

Dobjanschi

et al. 2024

Cureus

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Introduction: Cardiac autonomic neuropathy (CAN) is a disorder affecting the autonomic nerves that regulate the cardiovascular system, leading to irregular heart rate and blood pressure control. It is commonly associated with diabetes mellitus but can also result from other conditions such as autoimmune disorders, chronic kidney disease, alcohol abuse, and certain medications. Screening for CAN is essential, particularly in individuals with poor glycemic control, cardiovascular risk factors, or complications. Early identification of CAN is vital for timely intervention to prevent or manage cardiovascular complications effectively. Regular screening helps detect CAN before symptoms emerge, enabling early intervention to slow or halt its progression. This study examined the relationship between sudomotor function and cardiovascular reflex tests. Material and methods: This was a cross-sectional study conducted between June 2019 and June 2020. The study included 271 subjects aged 18 years and above who provided informed consent, were diagnosed with type 2 diabetes mellitus (T2DM), and were overweight or obese. Exclusion criteria encompassed patients with other types of diabetes, pregnant women, those with recent neoplasm diagnoses, stroke sequelae, history of myocardial infarction, or pelvic limb amputations. The assessment of cardiac autonomic neuropathy involved conducting an electrocardiogram and evaluating the QTc interval in the morning before taking medication. Additionally, cardiovascular reflex tests (CART) were conducted, including assessments of heart rate variability during deep breathing, the Valsalva maneuver, and changes in orthostatic position. Simultaneously, the diagnosis of CAN was assessed by performing a sweat test using a Sudoscan assessment (Impeto Medical, Moulineaux, France). Results: More than half of the participants (52%, n=143) were female. Significant differences in statistical measures were noted between females and males regarding age, systolic blood pressure, fasting blood glucose, A1c level, total cholesterol, triglycerides, gamma-glutamyl transferase, and bilirubin levels. Within the CAN-diagnosed group (CAN+), 40.92% were classified as mild cases (n=90), 47.27% as moderate cases (n=104), and 11.81% as severe cases (n=26). Among the CAN+ group, 54% (n=119) were women. Electrochemical skin conductance was lower in the CAN+ group than the CAN- group in hands (67.34±15.51 μS versus 72.38±12.12 μS, p=0.008) and feet (73.37±13.38 μS versus 82.84 ±10.29 μS, p<0.001). The Sudoscan-CAN score significantly correlated with Ewing scores (r= 0.522, p<0.001). In multiple linear regression analysis, the Sudoscan-CAN score remained significantly associated with age, high BMI, long-standing diabetes, and Ewing score. Conclusions: Sudoscan demonstrates potential in identifying patients with an increased risk of CAN. Its integration into clinical practice can improve patient outcomes through early detection, risk stratification, and personalized treatm...

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Masked nocturnal hypertension as a result of high prevalence of non-dippers among apparently well-controlled hypertensive patients with type 2 diabetes mellitus: data from a prospective study

Cited by 5 publications

References 53 publications

Masked Hypertension and Exaggerated Blood Pressure Response to Exercise: A Review and Meta-Analysis

Masked Hypertension and Exaggerated Blood Pressure Response to Exercise: A Review and Meta-Analysis

Perspectives on improving blood pressure control to reduce the clinical and economic burden of hypertension

The Importance of Evaluating Sudomotor Function in the Diagnosis of Cardiac Autonomic Neuropathy

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