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The phenomenon of masked hypertension (MH) is defined as a clinical condition in which a patient’s office blood pressure (BP) level is normal but ambulatory or home BP readings are in the hypertensive range. An increased prevalence of masked hypertension (MHT) has been demonstrated among patients with diabetes mellitus (DM). MHT appears to cause cardiovascular (CV) complications similar to clinically overt hypertension and is associated with increased macrovascular and microvascular complications in patients with DM population. In the light of these findings the aim of this study was to determine the prevalence and determinants of masked hypertension in diabetic patients and evaluate the relationship between HbA1c and MHT in diabetic patients.
This study included diabetic patients (n=80) with normal office blood pressure (<130/80 mmHg) with a mean age of 53,6±10,4 years. None of the participants were using antihypertensive medications. An ambulatory blood pressure monitorization (ABPM) was performed in all participants for 24 hours. HbA1c levels was measured and patients divided into two groups according to HbA1c levels. HbA1c was considered high if >6.5. There was no statistically significant difference about the demographic characteristics between the 2 groups. Masked hypertension was defined in diabetic patients as an office blood pressure(OBP) < 130/80 mmHg and mean ambulatory blood pressure > 125/75 mmHg.
80 diabetic patients had normal office blood pressure, of which 63% diagnosed to have masked hypertension based on established criteria. HbA1c levels were increased in the MHT group when compared normotensive diabetics (%70 in masked HT, %30 in normotansive group). Although this difference was not statistically significant, daily, night and mean systolic blood pressures were high in high HbA1c group (p=0.015, p=0.011, p=0.011). Additionally non-dipper pattern was more prevalant in the group with high HbA1c levels.
A significant fraction of T2DM patients with controlled office blood pressure were diagnosed with MHT. Our results indicate that in patients with impaired blood glucose regulation masked hypertension prevalance is increased.