Masked hypertension in type 2 diabetes mellitus : Relationship with left-ventricular structure and function

• Published in: American journal of hypertension Vol. 20; no. 10; pp. 1079 - 1084
• Main Authors: MARCHESI, Chiara, MARESCA, Andrea Maria, GRANDI, Anna Maria, SOLBIATI, Francesco, FRANZETTI, Ivano, LAURITA, Emanuela, NICOLINI, Eleonora, GIANNI, Monica, GUASTI, Luigina, MARNINI, Patrizio, VENCO, Achille
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Science 01.10.2007
• Subjects: Antihypertensive Agents - therapeutic use; Arterial hypertension. Arterial hypotension; Associated diseases and complications; Biological and medical sciences; Blood and lymphatic vessels; Blood Pressure - physiology; Blood Pressure Monitoring, Ambulatory; Cardiology. Vascular system; Cardiovascular Diseases - etiology; Case-Control Studies; Circadian Rhythm - physiology; Clinical manifestations. Epidemiology. Investigative techniques. Etiology; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - physiopathology; Diabetes. Impaired glucose tolerance; Echocardiography; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Female; Heart Ventricles - pathology; Heart Ventricles - physiopathology; Humans; Hypertension - complications; Hypertension - drug therapy; Hypertension - physiopathology; Male; Medical sciences; Middle Aged; Risk Factors; Ventricular Dysfunction, Left - pathology; Ventricular Dysfunction, Left - physiopathology; Ventricular Remodeling; Endocrinopathy; Type 2 diabetes; Hypertension; hypertrophy; Masked hypertension; Metabolic diseases; Cardiovascular disease; Left ventricle; 24-hour ambulatory BP monitoring; diastolic function; type 2 diabetes mellitus; Ambulatory; left ventricular; Left ventricle performance; Monitoring
• ISSN: 0895-7061; 1879-1905
• DOI: 10.1016/j.amjhyper.2007.06.005

To evaluate in type 2 diabetes mellitus the relationship between masked hypertension (MH) and left ventricular (LV) morpho-functional characteristics. Using 24-hour BP monitoring and echocardiography, we evaluated 71 type 2 diabetic patients, without overt cardiac disease and never treated with antihypertensive drugs: 45 normotensive subjects with clinic BP <130/85 mmHg and 26 sustained hypertensives (SH)(clinic BP > or = 140 and/or 90 mmHg and 24-hour BP > or =125 and/or 80 mmHg), matched for age, gender, BMI and duration of diabetes with clinically normotensive patients. MH was diagnosed with clinic BP <130/85 mmHg and 24-hour BP > or =125 and/or 80 mmHg. Among clinically normotensive patients, 21 (47%) had MH and 24 were true normotensive (NT, 24-hour BP <125/80 mmHg). LV mass increased from NT to MH to SH (p < 0.001); the parameters of LV diastolic function were similar between MH and SH and significantly lower than in NT. In type 2 diabetic patients with clinic BP <130/85 mmHg, MH is frequent and is associated with LV remodelling characterized by increased myocardial mass and preclinical impairment of LV diastolic function; the remodelling is qualitatively and for some aspects also quantitatively similar to that found in sustained hypertensive patients. Therefore it would be useful to look for MH in diabetic subjects with clinic BP <130/85 mmHg, who, following the guidelines, are not entitled to antihypertensive treatment: the finding of MH could identify a subgroup of patients at higher cardiovascular risk and therefore needing a prompt antihypertensive treatment.