Ambulatory Blood Pressure Monitoring in Patients with Type 2 Diabetes Mellitus - Preliminary Results — ASN Events
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  3. Ambulatory Blood Pressure Monitoring in Patients with Type 2 Diabetes Mellitus - Preliminary Results

Ambulatory Blood Pressure Monitoring in Patients with Type 2 Diabetes Mellitus - Preliminary Results (#331)

Florence Gunawan 1 , Hui Yi Ng 1 , Harry Harianto 1 , Mahesan Anpalahan 1 2 , Chris Gilfillan 1 3
  1. Department of General Internal Medicine, Eastern Health, Melbourne, Victoria, Australia
  2. Department of Medicine, North West Academic Centre, The University of Melbourne, Melbourne, Victoria, Australia
  3. Department of Endocrinology, Eastern Health, Melbourne, Victoria, Australia

Introduction: Current evidence suggests that ambulatory blood pressure monitoring (ABPM) is integral to the diagnosis and management of hypertension (HT)1. However, its clinical utility has not yet been adequately validated in diabetes. 

Aims: To determine the adequacy of blood pressure control, the prevalence of abnormal circadian blood pressure patterns and the prevalence of white coat (WCHT) and masked hypertension (MHT) in patients with Type 2 Diabetes (T2DM).

Measurements:  Preliminary analysis of a larger prospective observational study of patients seen in diabetic clinics at Eastern Health. Clinic BP was obtained under standardised conditions.  24-hour ABPM was performed on patient’s non-dominant arm using a TM2430 ambulatory blood pressure monitor. Measurements were recorded every 30 minutes.  Standard ABP diagnostic criteria were used to define BP control and abnormal ABP patterns. 

Results: 37 patients underwent ABPM (mean age 69±10 years; 51% males; mean duration of T2DM 17±11 years). 31 had a diagnosis of HT and received 1.8±1.1 antihypertensive medications.  The mean clinic BP in patients with and without a diagnosis of HT was 140/75±20/10mmHg and 127/76±14/9mmHg, respectively. The corresponding mean 24-hr ABP was 135/74±14/7mmHg and 138/82±14/10mmHg, respectively. Non or reverse dipping was prevalent in 18 (49%) and this included 4 without a previous diagnosis of HT.  MHT was present in 5 (83%) (mean clinic BP 128/76±16/10 mmHg vs. 24hr-ABP 144/84±9/9mmHg) and masked uncontrolled HT in 4 (13%) (mean clinic BP 126/73±15/10mmHg vs. 24hr-ABP138/79±9/9mmHg).  None had WCHT whereas two treated patients demonstrated ‘white coat effect’. Non or reverse dipping was not associated with diabetic complications (P= 0.89) or poor diabetic control (HBA1C > 7 P= 0.62).

Conclusion: Non or reverse dipping and masked phenomenon are common in patients with T2DM regardless of diabetic complications. Routine ABPM may improve their clinical care.

  1. 1. The Clinical Utility of Ambulatory Blood Pressure Monitoring (ABPM): a review. Harianto H, Valente M, Hoetomo S, Anpalahan M. Curr Hypertens Rev. 2014;10(4):189-204