Title: Masked hypertension in diabetes mellitus: treatment implications for clinical practice
Authors: Franklin, Stanley S
Thijs, Lutgarde
Li, Yan
Hansen, Tine W
Boggia, José
Liu, Yanping
Asayama, Kei
Björklund-Bodegård, Kristina
Ohkubo, Takayoshi
Jeppesen, Jørgen
Torp-Pedersen, Christian
Dolan, Eamon
Kuznetsova, Tatiana
Stolarz-Skrzypek, Katarzyna
Tikhonoff, Valérie
Malyutina, Sofia
Casiglia, Edoardo
Nikitin, Yuri
Lind, Lars
Sandoya, Edgardo
Kawecka-Jaszcz, Kalina
Filipovsky, Jan
Imai, Yutaka
Wang, Jiguang
Ibsen, Hans
O'Brien, Eoin
Staessen, Jan A ×
International Database on Ambulatory blood pressure in relation to Cardiovascular Outcomes (IDACO) Investigators #
Issue Date: May-2013
Publisher: Lippincott Williams & Wilkins
Series Title: Hypertension vol:61 issue:5 pages:964-71
Article number: 10.1161/HYPERTENSIONAHA.111.00289
Abstract: Although distinguishing features of masked hypertension in diabetics are well known, the significance of antihypertensive treatment on clinical practice decisions has not been fully explored. We analyzed 9691 subjects from the population-based 11-country International Database on Ambulatory Blood Pressure in Relation to Cardiovascular Outcomes. Prevalence of masked hypertension in untreated normotensive participants was higher (P<0.0001) among 229 diabetics (29.3%, n=67) than among 5486 nondiabetics (18.8%, n=1031). Over a median of 11.0 years of follow-up, the adjusted risk for a composite cardiovascular end point in untreated diabetic-masked hypertensives tended to be higher than in normotensives (hazard rate [HR], 1.96; 95% confidence interval [CI], 0.97-3.97; P=0.059), similar to untreated stage 1 hypertensives (HR, 1.07; CI, 0.58-1.98; P=0.82), but less than stage 2 hypertensives (HR, 0.53; CI, 0.29-0.99; P=0.048). In contrast, cardiovascular risk was not significantly different in antihypertensive-treated diabetic-masked hypertensives, as compared with the normotensive comparator group (HR, 1.13; CI, 0.54-2.35; P=0.75), stage 1 hypertensives (HR, 0.91; CI, 0.49-1.69; P=0.76), and stage 2 hypertensives (HR, 0.65; CI, 0.35-1.20; P=0.17). In the untreated diabetic-masked hypertensive population, mean conventional systolic/diastolic blood pressure was 129.2±8.0/76.0±7.3 mm Hg, and mean daytime systolic/diastolic blood pressure 141.5±9.1/83.7±6.5 mm Hg. In conclusion, masked hypertension occurred in 29% of untreated diabetics, had comparable cardiovascular risk as stage 1 hypertension, and would require considerable reduction in conventional blood pressure to reach daytime ambulatory treatment goal. Importantly, many hypertensive diabetics when receiving antihypertensive therapy can present with normalized conventional and elevated ambulatory blood pressure that mimics masked hypertension.
ISSN: 0194-911X
Publication status: published
KU Leuven publication type: IT
Appears in Collections:Hypertension and Cardiovascular Epidemiology
× corresponding author
# (joint) last author

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