Usefulness of Home Blood Pressure Measurement in the Morning in Patients with Type 2 Diabetes: Long-Term Results of a Prospective Longitudinal Study

Abstract

Previous cross-sectional studies have demonstrated that blood pressure measurements at home (HBP) in the morning display stronger predictive power for micro- and macrovascular complications in type 1 and 2 diabetic patients than casual/clinic blood pressure (CBP) measurements. This longitudinal study investigated which of these measurements offers stronger predictive power for outcomes over 6 years. At baseline, 400 Japanese patients with type 2 diabetes were classified as hypertensive or normotensive based on HBP and CBP measurements. Mean (+/-SD) survey duration of all patients was 42.1 +/- 20.0 months (range, 3-72 months). Primary and secondary endpoints were death and new, worsened, or improved micro- and macrovascular events, respectively. Differences in outcomes for each endpoint between hypertensive and normotensive patients in each group were analyzed using survival curves from Kaplan-Meier analysis and log-rank testing. Associated risk factors related to outcomes were assessed using Cox proportional hazards modeling. On the basis of HBP, cumulative events of death and new or worsened microvascular diseases were significantly higher in hypertensive patients than in normotensive patients. On the basis of CBP, no significant differences were identified. New or worsened macrovascular events were significantly higher in hypertensive patients than in normotensive patients on the basis of both HBP and CBP. One associated risk factor was morning hypertension. A longitudinal study of type 2 diabetic patients demonstrated that elevated HBP in the morning is predictive of micro- and macrovascular complications.

Home Blood Pressure Measurement in the Morning Related to Cancer in Patients with Type 2 Diabetes Mellitus: 10 Years-Term Results of a Longitudinal Study and Cancer

“…Subjects comprised 400 Japanese patients with T2DM enrolled between 1999 and 2005 [3]. After a detailed *Address correspondence to this author at the Joetsu General Hospital, Joetsu, Niigata, 943-0502, Japan; Tel: +81-0258-36-3986; Fax: +81-0258-36-3986; E-mail: kkam-int@echigo.ne.jp baseline examination, subjects were followed up for allcause mortality and morbidity, and event of cancer.…”

“…Baseline characteristics of participants have been described previously [3]. At beginning of the study, 329 patients (82%) were receiving treatment with oral hypoglycemic drugs and/or insulin regimens for hyperglycemia, 196 patients (49%) were receiving treatment with various antihypertensive drugs for HT, and no patient was receiving treatment for anemia [3,4].…”

“…Previous cross-sectional studies [1,2], and 6-year [3] and 10-year [4] longitudinal studies have demonstrated that home blood pressure (HBP) measurements upon awakening have better predictive power for death and micro-and macrovascular complications in patients with type 1 and 2 diabetes mellitus (T2DM) than casual/clinic BP (CBP) measurements.…”

Reduction in Morning Blood Pressure Is a Key Factor for Ameliorating Urinary Albumin Excretion in Patients With Morning Hypertension Irrespective of Treatment Regimen

“…This observation was consistent with a previous study showing that morning BP was a stronger predictor for UAE than clinic BP. 15 It is interesting to note that morning SBP reduction was significantly correlated with UAE reduction even after adjustment for baseline UACR and other confounding factors (Figure 2). Moreover, the subgroup analysis showed that morning SBP reduction is an independent determinant of UAE reduction in both the combination regimen and high-dose regimen.…”

Prevention for Micro- and Macro-Vascular Complications in Diabetic Patients

“…while 3, 1, 1 and 1 patients in the CH group were due to cancer with brain, breast or pancreas, CVD, CHD and unknown cause, respectively, and 2 and 1 patients in the CN group were due to CVD and CHD, respectively (Kamoi et al, 2010). As shown in figure 7, new or worsened events of microvascular complications were observed in 72 patients (18%) included 36 with retinopathy and 59 with nephropathy, while improved events of microvascular complications were shown in 102 patients (25.5%) included 27 with retinopathy and 79 with nephropathy.…”