title: Masked hypertension in diabetes mellitus: treatment implications for clinical practice.
abstract: Although distinguishing features of masked hypertension in diabetics are well known, the significance of antihypertensive treatment on clinical practice decisions has not been fully explored. We analyzed 9691 subjects from the population-based 11-country International Database on Ambulatory Blood Pressure in Relation to Cardiovascular Outcomes. Prevalence of masked hypertension in untreated normotensive participants was higher (P<0.0001) among 229 diabetics (29.3%, n=67) than among 5486 nondiabetics (18.8%, n=1031). Over a median of 11.0 years of follow-up, the adjusted risk for a composite cardiovascular end point in untreated diabetic-masked hypertensives tended to be higher than in normotensives (hazard rate [HR], 1.96; 95% confidence interval [CI], 0.97-3.97; P=0.059), similar to untreated stage 1 hypertensives (HR, 1.07; CI, 0.58-1.98; P=0.82), but less than stage 2 hypertensives (HR, 0.53; CI, 0.29-0.99; P=0.048). In contrast, cardiovascular risk was not significantly different in antihypertensive-treated diabetic-masked hypertensives, as compared with the normotensive comparator group (HR, 1.13; CI, 0.54-2.35; P=0.75), stage 1 hypertensives (HR, 0.91; CI, 0.49-1.69; P=0.76), and stage 2 hypertensives (HR, 0.65; CI, 0.35-1.20; P=0.17). In the untreated diabetic-masked hypertensive population, mean conventional systolic/diastolic blood pressure was 129.2 ± 8.0/76.0 ± 7.3 mm Hg, and mean daytime systolic/diastolic blood pressure 141.5 ± 9.1/83.7 ± 6.5 mm Hg. In conclusion, masked hypertension occurred in 29% of untreated diabetics, had comparable cardiovascular risk as stage 1 hypertension, and would require considerable reduction in conventional blood pressure to reach daytime ambulatory treatment goal. Importantly, many hypertensive diabetics when receiving antihypertensive therapy can present with normalized conventional and elevated ambulatory blood pressure that mimics masked hypertension.
authors.affiliation: Heart Disease Prevention Program, Division of Cardiology, School of Medicine, University of California, Irvine, California, USA.
authors.forename: Stanley S
authors.initials: SS
authors.lastname: Franklin
authors.forename: Lutgarde
authors.initials: L
authors.lastname: Thijs
authors.forename: Yan
authors.initials: Y
authors.lastname: Li
authors.forename: Tine W
authors.initials: TW
authors.lastname: Hansen
authors.forename: José
authors.initials: J
authors.lastname: Boggia
authors.forename: Yanping
authors.initials: Y
authors.lastname: Liu
authors.forename: Kei
authors.initials: K
authors.lastname: Asayama
authors.forename: Kristina
authors.initials: K
authors.lastname: Björklund-Bodegård
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Ohkubo
authors.forename: Jørgen
authors.initials: J
authors.lastname: Jeppesen
authors.forename: Christian
authors.initials: C
authors.lastname: Torp-Pedersen
authors.forename: Eamon
authors.initials: E
authors.lastname: Dolan
authors.forename: Tatiana
authors.initials: T
authors.lastname: Kuznetsova
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Stolarz-Skrzypek
authors.forename: Valérie
authors.initials: V
authors.lastname: Tikhonoff
authors.forename: Sofia
authors.initials: S
authors.lastname: Malyutina
authors.forename: Edoardo
authors.initials: E
authors.lastname: Casiglia
authors.forename: Yuri
authors.initials: Y
authors.lastname: Nikitin
authors.forename: Lars
authors.initials: L
authors.lastname: Lind
authors.forename: Edgardo
authors.initials: E
authors.lastname: Sandoya
authors.forename: Kalina
authors.initials: K
authors.lastname: Kawecka-Jaszcz
authors.forename: Jan
authors.initials: J
authors.lastname: Filipovsky
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Imai
authors.forename: Jiguang
authors.initials: J
authors.lastname: Wang
authors.forename: Hans
authors.initials: H
authors.lastname: Ibsen
authors.forename: Eoin
authors.initials: E
authors.lastname: O'Brien
authors.forename: Jan A
authors.initials: JA
authors.lastname: Staessen
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D001795:Blood Pressure Determination / Q000379:methods; D002318:Cardiovascular Diseases / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007391:International Cooperation; D008297:Male; D059468:Masked Hypertension / Q000188:drug therapy* / Q000453:epidemiology*; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents