title: The value of serum asymmetric dimethylarginine levels for the determination of masked hypertension in patients with diabetes mellitus.
abstract: BACKGROUND
  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. Asymmetric dimethylarginine (ADMA) is an endogenous nitric oxide inhibitor and higher plasma levels of ADMA are related to increased CV risk in both the general population and among patients with DM. The aim of this study was to evaluate the relationship between MHT and ADMA in diabetic patients.
  
  
  METHODS
  This study included DM patients (n = 131) with normal office blood pressure (<140/90 mmHg). None of the participants were using antihypertensive medications. All participants utilized an ambulatory blood pressure monitor (ABPM) for 24 h. Serum ADMA and arginine levels were measured using the fluorescence detector high performance liquid chromatography method.
  
  
  RESULTS
  The prevalence of MHT was 24.4% among the study subjects. ADMA levels were increased in the MHT group when compared with normotensive diabetics (6.2 ± 2.2 vs 4.2 ± 1.7 μmol/L p = 0.001, respectively). Furthermore, arginine/ADMA ratio was lower in the MHT group than among the normotensive group (29.9 ± 12.1 vs 46.0 ± 19.0 p = 0.001). In the multivariate logistic regression model, ADMA, BMI and HDL levels were found to be independent predictors of MHT Odds ratio: 1.63 (1.28-2.06), 1.19 (1.05-1.35), and 0.95 (0.90-0.99), respectively. The cut-off value of the ADMA was 4.34 μmol/L with a sensitivity, specificity, positive predictive value, and negative predictive value of 84.4%, 59.6%, of 40.3%, and 92.2%, respectively (AUC = 0.78).
  
  
  CONCLUSIONS
  Serum ADMA may play a role in both the pathophysiology and screening of MHT in DM subjects.
authors.affiliation: Department of Biochemistry, Dr Faruk Sükan Maternity and Children's Hospital, Konya, Turkey. alparslantaner@hotmail.com
authors.forename: Alpaslan
authors.initials: A
authors.lastname: Taner
authors.forename: Ali
authors.initials: A
authors.lastname: Unlu
authors.forename: Mehmet
authors.initials: M
authors.lastname: Kayrak
authors.forename: Mehmet
authors.initials: M
authors.lastname: Tekinalp
authors.forename: Selim S
authors.initials: SS
authors.lastname: Ayhan
authors.forename: Alpay
authors.initials: A
authors.lastname: Arıbaş
authors.forename: Said Sami
authors.initials: SS
authors.lastname: Erdem
mesh_terms: D000328:Adult; D001120:Arginine / Q000031:analogs & derivatives* / Q000097:blood; D015415:Biomarkers / Q000097:blood; D018660:Blood Pressure Monitoring, Ambulatory; D016009:Chi-Square Distribution; D002851:Chromatography, High Pressure Liquid; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000453:epidemiology; D005260:Female; D005453:Fluorescence; D006801:Humans; D006973:Hypertension / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D015995:Prevalence; D012307:Risk Factors; D014421:Turkey / Q000453:epidemiology
chemical_list: D015415:Biomarkers; C018524:N,N-dimethylarginine; D001120:Arginine