Compaison between office blood pressure with ambulatory blood pressure recordings in diabetic patients

Abstract

Background: Hypertension is major risk factor for cardiovascular mortality and morbidity, especially in patients with diabetes mellitus. Classically BP measurements are office based which may not reflect true BP patterns. Twenty-four ABPM is a precise method to quantify BP levels and diagnose hypertension.

Objective: To compare office blood pressure with ambulatory blood pressure recordings in diabetic patients

Study design: Cross sectional observational.

Participants: The study population consisted of 200 patients ;Age ranged from 26-84 years (median 52) ;71 (35.5%) were males and 129 (64.5%) were females.

Materials and methods: The current study was conducted in total number of 200 diabetic subjects over a period of two years. Before doing ABPM all the baseline parameters were taken. Office BP was measured according to standardized procedure with the use of calibrated mercury sphygmomanometers with cuffs of adequate size. Thereafter 24 hour ambulatory blood pressure monitoring (ABPM) was performed with validated, automated, oscillometric device (Meditech device) that was programmed to record BP at 15 minute intervals during the day (day time interval was set between 6 am to 10 pm) and at 30 minute intervals during the night (night interval was set between10 pm to 6 am) . Thereafter blood pressure recordings were compared with each other.

Results: The study population was divided into two groups; Controlled BP and Uncontrolled BP. Out of 83 patients with controlled BP on office measurements, 35 were treatment naïve and 48 were on antihypertensives. Masked hypertension was found in 13 (37.2%) and masked effect was found in 23 (48%) . Out of 117 patients with uncontrolled BP on office measurements, 99 were on antihypertensive medication and 18 were newly detected and not on any medication. White coat hypertension was found in 7 (38.8%) and white coat effect was seen in 20 (20.3%) . The study also showed prevalence of isolated nocturnal hypertension to be around 22.8%.

Conclusion: By Relying exclusively on conventional blood pressure measurements, true patterns of BP in patients with diabetes may not be identified. So ambulatory BP monitoring is a valuable addition to the techniques which help in diagnosis and treatment of hypertension in diabetic patients especially who appear to have normal BP.

Implications: It is suggested to change the traditional practice to diagnose and manage hypertension from traditional office BP monitoring to 24 hour ABPM.