Should 24-h Ambulatory Blood Pressure Monitoring Be Done in Every Patient With Diabetes?

Parati, Gianfranco; Bilo, Grzegorz

doi:10.2337/dc09-s326

Cited by 40 publications

(41 citation statements)

References 48 publications

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“…Focus on conventional office BP only was a common approach in most available RDN studies, an approach that is somehow surprising, on the background of the growing awareness of the limitations of office BP measurements and of the acknowledged need to combine them with out-of-office BP monitoring through home self-BP measurements or, even better, through 24-hour ambulatory BP monitoring (ABPM). 8,9 Basing available RDN studies on office BP measurements only, and thus failing to exclude patients whose office BP elevation was largely attributable to a white-coat effect, 10 also raises some ethical concerns, because the contribution of the white-coat effect to cardiovascular risk is modest, 11 and the prognostic benefits (if any) derived from improving office BP control in subjects with controlled out-of-office BP may not outweigh the risks of an invasive procedure such as RDN. Indeed, ABPM was only performed in a small subset of Symplicity participants, and the principal assessment of efficacy was based on office BP.…”

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confidence: 99%

Renal Sympathetic Denervation and Daily Life Blood Pressure in Resistant Hypertension

2013

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confidence: 99%

Renal Sympathetic Denervation and Daily Life Blood Pressure in Resistant Hypertension

2013

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“…In particular, the lack of established ABPM partition values for defining hypertension diagnosis and therapeutic targets in diabetic patients remains an important unresolved issue. 39 Most importantly, the significance of either uncontrolled isolated office hypertension or isolated office hypertension to predict future cardiovascular morbidity and mortality remains unsettled. Studies focusing on target-organ damage suggested that patients with isolated office hypertension may be at an intermediate risk between sustained normotensives and those with sustained hypertension.…”

Section: Discussionmentioning

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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“…As mentioned above, some particular aspects of cardiovascular AD can be detected with ABPM. These include: reduced nocturnal BP fall (non-dipping pattern), increase of BP during night (reverse dipping pattern), whose prevalence reaches up to 30 % in diabetic subjects [5], elevated BP variability (SD of mean 24-h, daytime, and night-time), OH and PH, and reduced HR variability/reduced nocturnal HR fall. These abnormalities are predictive of poorer prognosis and ABPM is crucial for refining the cardiovascular risk profile of these subjects.…”

Section: Characteristics Of Cardiovascular Autonomic Dysfunction Detementioning

confidence: 99%

Autonomic Dysfunction: How to Identify and When to Treat?

Saladini

Marco²,

Palatini

2016

High Blood Press Cardiovasc Prev

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Cardiovascular autonomic dysfunction (AD) is a particular condition that can be detected by means of ambulatory blood pressure monitoring (ABPM). ABPM is helpful to identify some specific characteristics of haemodynamic AD, including non-dipping/reverse-dipping pattern, orthostatic and post-prandial hypotension and elevated blood pressure variability. These characteristics may be misdiagnosed with traditional, clinic blood pressure measurements. AD is relatively common in the real world. By analysing about 1000 recordings in a Cardiology unit, AD was found in 6.8 % of the exams. Several diseases may be the underlying causes of AD. In our sample half of the subjects were diabetic (54.4 %), 17.7 % were patients with alpha-synucleinopathy (Parkinson disease or multiple system atrophy), and 27.9 % had other underlying causes of AD including chronic kidney disease, α-lytic drug assumption and AD from unknown causes. According to the different aetiology, different clinical characteristics can be found, in particular in diabetics these peculiar aspects are less pronounced compared to the other subgroups. These characteristics have been found to be predictors of cardiovascular events, organ damage, and mortality. For these reasons, early identification of these behaviours is important, in order to better define patient's cardiovascular risk profile. As regard treatment of AD, several drugs have been tested, however none of this showed efficacy in all kinds of patients. Another open aspect is "safe" reference values for supine hypertension.

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Should 24-h Ambulatory Blood Pressure Monitoring Be Done in Every Patient With Diabetes?

Cited by 40 publications

References 48 publications

Renal Sympathetic Denervation and Daily Life Blood Pressure in Resistant Hypertension

Renal Sympathetic Denervation and Daily Life Blood Pressure in Resistant Hypertension

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

Autonomic Dysfunction: How to Identify and When to Treat?

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