Ambulatory Blood Pressure Measurement Control in Hypertensive Treated Diabetic Patients

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Published Nov 26, 2010
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Vol. 88 No. 12 (2010): Issue Dec 2010

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Faouzi Kanoun
Nefissa Ben Alaya
salma Idriss
Noureddine Sayem
Malika Chihaoui
Fatma Harzallah
Hedia Slimane

Abstract

Background: Good blood pressure control is one of the recommended targets in diabetic patient’s management.
Aim: To evaluate blood pressure (BP) control in hypertensive treated diabetic patients using ambulatory blood pressure measurement (ABPM).
Methods: Two hundred and six hypertensive treated diabetic patients were enrolled in this study (83 men and 123 women). Mean age were 60.3 ± 9.6 years-old with mean diabetic duration of 9.1 ± 8.2 years.
All of them underwent 24 hours ABPM. Intervals between measurements were 20 minutes at diurnal period and 30 minutes at nocturnal period.
Results: 28 patients (13.6%) only were at recommended target levels of blood pressure control (mean diurnal BP < 130/80 mmHg and nocturnal BP < 115/65 mmHg) and 137 patients were at the most bed control levels (mean diurnal BP ? 140/90 mmHg or nocturnal BP ? 125/75 mmHg). Bed controlled patients had mildly higher waist circumference (p=0.08). Poor BP control was associated with non dipper character (p<0.001), diabetic nephropathy (p<0.01) and diabetic retinopathy (p<0.01).
Conclusion: Our hypertensive treated diabetic patients were far from good blood pressure control. ABPM showed that the loss of nocturnal blood pressure fall was the most associated abnormality with poor BP control. Diabetic microangiopathy were more frequent in poor controlled patients

Keywords:

Diabetes, Hypertension, AMBP, microangiopathy

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References

  1. Perneger TN, Brancati FL, Whelton PK, Flag ML. End stage renal disease attributable to diabetes mellitus. Ann Intern Med 1994; 121: 912- 8.
  2. Sharret AR, Hubbard LD, Cooper LS et al. Retinal arteriolar diameters and elevated blood pressure. The atherosclerosis risk in communities study. Am J Epidemiol 1999; 150: 263-70.
  3. Wan Nazaimoan WN, Letchuman R, Noraini N et al. Systolic hypertension and duration of diabetes mellitus are important determinant of retinopathy and microalbuminuria in young diabetics. Dibetes Res Clin Pract 1999; 46: 213-21.
  4. Stamler J, Vaccaro O, Neaton JD, wentworth D. Diabetes, others risk factors, and 12 years cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial. Diabetes care 1993; 16: 434-44.
  5. Turner RC, Millus H, Sratton IM, Manley SE, Matthews DR, Holman RR, and the UKPDS. Risk factors for coronary artery disease in non insulindependent diabetes mellitus: UKPDS 23. Br Med. J 1998; 316: 823-8.
  6. Bouhanick B, Bernut G, Fabbri P, Marre M. Nephropathy in non dependent diabetics. Presse Méd 1996; 25: 1251-6.
  7. Schmitz A, Voeth M, Mogensen CE. Systolic blood pressure relates to the rate of progression of albuminuria in NIDDM. Diabetologia 1994; 37: 1251-8.
  8. Roy MS. Diabetic retinopathy in african americans with type1 diabetes: the New Jersey 725. Risk factors. Arch ophtalmol 2000; 118: 105-15.
  9. Knowler WC, Bennet BH, Ballentine EJ. Increased incidence of retinopathy in diabetics with elevated blood pressure. Asix-year followup study in pima Indians. N Engl. J Med. 1980; 302: 645-50.
  10. Vijan S, Hofer TP, Hayward RA. Cost-Utility Analysis of Screening Intervals for Diabetic Retinopathy in patients with type2 Diabetes Mellitus. JAMA 2000;283: 889-96.
  11. U.K. Prospective diabetes study group. Overview of 6 years therapy of type2 diabetes: a progressive disease. Diabetes 1995; 44: 1249-58.
  12. Chaubanien AV, Bakris GL, Blak HR et al. The seventh report of the Joint National Committee on prevention, detection evaluation and treatment of high blood pressure, The JNC 7 Report, JAMA 2003;289:2560-72.
  13. Guidelines Committee. 2003 European Society of Hypertension - European Society of Cardiology Guidelines for the management of arterial hypertension. J hypertens 2003; 21:1011-53.
  14. O'Brien E, Asmar R, Beilin L et al. European society of hypertension recommendations for conventional, ambulatory and home blood pressure measurements. J Hypertens 2003; 21: 821-48.
  15. Kaplan NM. Misdiagnosis of systemic hypertension and recommendations for improvement. Am J Cardiol 1987; 60: 1383-6.
  16. Gueyffier F, Cornu C, Bossard N et al. Intérêt pronostique de la mesure ambulatoire de pression artérielle en France. Premiers résultats de l'étude OCTAVE II. Arch Mal C?ur 1999 ; 92 : 1151-7.
  17. Bauduceau B, Gautier D, Nizou C, Reboul P, Chanudet X, Larroque P. Rôle de l'hypertension artérielle nocturne dans l'aggravation de néphropathie diabétique. Arch Mal C?ur 1991 ; 84 : 1105-9.
  18. Benhamou PY, Halimi S, De Gaudimaris R et al. Early disturbances of ambulatory blood pressure in normotensive type1 diabetic patients with microalbuminuria. Diabetes care 1992; 15:1614-9 .
  19. Liniger C, Favre L, Assal JP. Twenty-four hour blood pressure and heart rate profiles of diabetic patients with abnormal cardiovascular reflexes. Diabetic Med 1991; 8: 420-7.
  20. Parati G, Ravogli A, Frattola Aet al. Blood pressure variability: Clinical implications and effects of antihypertensive treatment. J Hypertension 1994; 12 (suppl 5): S35-S40.
  21. UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvaascular complications in type2 diabetes. UKPDS 38. BMJ 1998; 317: 703-13.
  22. Chobanian.AV, Bakris.GL, Black.HR et al. The seventh report of the Joint National Committee on Prevention, Evaluation, and Treatement of High Blood Pressure. JAMA 2003; 289: 2560-72.
  23. European Society of hypertension. European Society of cardiology guidelines for the management of arterial hypertension. J Hypertens 2003; 21: 1011-53.
  24. Staessen J, O'Brien E, Amery A, Atkin SN, Baumgart P, Decart P. Ambulatory blood pressure in normotensive and hypertensive subjects: results from an international data bone. J Hypertens 1992; 12: S1-S12.
  25. Timio M, Venanzi S, Lolli S et al. “Non dipper” hypertensive patients and progressive renal insufficiency: a 3-year longitudinal study. Clinical Nephrology 1995; 43: 382-7.
  26. Burt VL, Cutler YA, Higgins M et al. Trends in the prevalence, awareness, treatment and control of hypertension in the adults US population. Data from the health examination surveys 1960-1991. Hypertension 1995; 26: 60-5.
  27. Zanchetti A. Contribution of fixed low-dose combinations to initial therapy in hypertension. Eur Heart J 1999; 1(Suppl L): L5-L9.
  28. Pickering TG, Harshfield GA, Kleinert HD, Blank S, Laragh JH. Blood pressure during normal daily activities, sleep, and exercise: comparison of values in normal and hypertensive subjects. JAMA 1982; 247:992-6.
  29. Parati G, Valentini M. Prognostic relevance of blood pressure variability. Hypertension 2006;47:138-8.
  30. Reaven GM. Banting Lecture 1988. Role of insulin resistance in human disease. Diabetes. 1988;37:1595-1607.
  31. Cuspidi C, Lonati L, Sampieri L et al. Prevalence of target organ damage in treated Hypertensive patients: different impact of clinic and ambulatory blood pressure control. J Hypertens 2000; 18: 803-9.