Frequency of masked hypertension in non-obese diabetics and obese diabetics
Keywords:Masked hypertension, Non-obese diabetics, Obese diabetics
Background: Masked hypertension defined as clinic BP <140/90mmHg but home BP is in the hypertensive range of >135/85mmhg. It is an emerging clinical entity. Several risk factors, including sex, age, diabetes, obesity, smoking, have been associated with it. Masked hypertensives are usually under-treated and are at risk of cardiovascular complications. As the prevalence is high it is necessary to determine its frequency. Objectives was to evaluate the frequency of masked hypertension in non-obese diabetics and obese diabetics who had never been treated for hypertension.
Methods: The study was carried out in JSS hospital, Mysore over a period of 2 years from 2014 to 2016. The study was designated as a comparative and exploratory study. 200 people each of non-obese diabetics and obese diabetics were selected based on inclusion and exclusion criteria. Clinic SBP and DBP was recorded and self-monitoring automatic BP apparatus was given to record home SBP and DBP. Each patient was categorized into either of the four groups normotension, sustained hypertension, masked hypertension and white coat hypertension.
Results: Frequency of masked hypertension among non-obese diabetics and obese diabetics is 16% and 20% respectively. Average clinic SBP, DBP home SBP and DBP among non-obese diabetics with masked hypertension are 133.06, 83.15, 139.06 and 84.45 respectively when compared to normotensive which are 113.44, 71.46, 109.81, 70.86 respectively (significant p value of <0.0001). Average clinic SBP, DBP home SBP and DBP among obese diabetics with masked hypertension are 135.60, 84.13, 140.63, and 86.93 respectively when compared to normotensive which are 117.80, 74.10, 115.59, 72.71 respectively (significant p value of <0.0001).
Conclusions: In summary, present study demonstrated frequency of masked hypertension among non-obese diabetics and obese diabetics was higher when compared with other studies done on general population. There are no studies done on masked hypertension among obese and non-obese diabetics for proper comparison of data from current study. As the frequency is higher in both non-obese diabetic and obese diabetic groups in current study it signifies the importance of recording the home blood pressures to detect masked hypertension.
O'brien E, Asmar R, Beilin L, Imai Y, Mancia G, Mengden T, et al. Practice guidelines of the European society of hypertension for clinic, ambulatory and self-blood pressure measurement. J Hypertens. 2005;23(4):697-701.
Bobrie G, Chatellier G, Genes N, Clerson P, Vaur L, Vaisse B, et al. Cardiovascular prognosis of “masked hypertension” detected by blood pressure self-measurement in elderly treated hypertensive patients. JAMA. 2004;291(11):1342-9.
Imai Y, Tsuji I, Nagai K, Sakuma M, Ohkubo T, Watanabe N, et al. Ambulatory blood pressure monitoring in evaluating the prevalence of hypertension in adults in Ohasama, a rural Japanese community. Hypertens Res. 1996;19:207-12.
Sega R, Trocino G, Lanzarotti A, Carugo S, Cesana G, Schiavina R, et al. Alterations of cardiac structure in patients with isolated office, ambulatory, or home hypertension. Circulation. 2001;104:1385-92.
Bjorklund K, Lind L, Zethelius B, Andren B, Lithell H. Isolated ambulatory hypertension predicts cardiovascular morbidity in elderly men. Circulation. 2003;107:1297-302.
Liu JE, Roman MJ, Pini R, Schwartz JE, Pickering TG, Devereux RB. Cardiac and arterial target organ damage in adults with elevated ambulatory and normal office blood pressure. Ann Intern Med. 1999;131:564-72.
Selenta C, Hogan BE, Linden W. How often do office blood pressure measurements fail to identify true hypertension? An exploration of white-coat normotension. Arch Fam Med. 2000;9:533-40.
Ohkubo T, Kikuya M, Metoki H, Asayama K, Obara T, Hashimoto J, et al. Prognosis of “masked” hypertension and “white coat” hypertension detected by 24-h ambulatory blood pressure monitoring 10-years follow up from the Ohasama study. J Am Coll Cardiol .2005;46:508-15.
Mancia G, Facchetti R, Bombelli M, Grassi G, Sega R. Long-term risk of mortality associated with selective and combined elevation in office, home, and ambulatory blood pressure. Hypertension. 2006;47:846-53.
Kannel WB, Wilson PW, Zhang TJ. The epidemiology of impaired glucose tolerance and hypertension. Am Heart J. 1991;121(4):1268-73.
Stamler J, Vaccaro O, Neaton JD, Wentworth D. Diabetes, other risk factors, and 12-years cardiovascular mortality for men screened in the multiple risk factor intervention trial. Diabetes Care. 1993;16:434-44.
Thijs L, Hansen TW, Kikuya M, Bjorklund-Bodegård K, Li Y, Dolan E, et al. The international database of ambulatory blood pressure in relation to cardiovascular outcome (IDACO): protocol and research perspectives. Blood Press Monit. 2007;12:255-62.
Sayama K, Sato A, Ohkubo T, Mimura A, Hayashi K, Kikuya M, et al. The association between masked hypertension and waist circumference as an obesity-related anthropometric index for metabolic syndrome: the Ohasama study. Hypertension Research. 2009;32(6):438-43.
Sehestedt T, Hansen TW, Richart T, Boggia J, Kikuya M, Thijs L, et al. Are blood pressure and diabetes additive or synergistic risk factors? Outcome in 8494 subjects randomly recruited from 10 populations. Hypertens Res. 2011;34:714-21.
Kramer CK, Leitao CB, Canani LH, Gross JL. Impact of white-coat hypertension on microvascular complications in type 2 diabetes. Diabetes Care. 2008;31(12):2233-7.