Masked hypertension in type 2 diabetes mellitus. Relationship with left-ventricular structure and function.
BACKGROUND
To evaluate in type 2 diabetes mellitus the relationship between masked hypertension (MH) and left ventricular (LV) morpho-functional characteristics.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Marchesi
Chiara
C
Department of Clinical Medicine, University of Insubria, Varese, Italy. chiara.mrc@gmail.com
Maresca
Andrea Maria
AM
Solbiati
Francesco
F
Franzetti
Ivano
I
Laurita
Emanuela
E
Nicolini
Eleonora
E
Gianni
Monica
M
Guasti
Luigina
L
Marnini
Patrizio
P
Venco
Achille
A
Grandi
Anna Maria
AM
D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000502:physiology; D018660:Blood Pressure Monitoring, Ambulatory; D002318:Cardiovascular Diseases / Q000209:etiology; D016022:Case-Control Studies; D002940:Circadian Rhythm / Q000502:physiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000503:physiopathology*; D004452:Echocardiography; D005260:Female; D006352:Heart Ventricles / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D018487:Ventricular Dysfunction, Left / Q000473:pathology / Q000503:physiopathology*; D020257:Ventricular Remodeling
D000959:Antihypertensive Agents