title: An assessment of discriminatory power of office blood pressure measurements in predicting optimal ambulatory blood pressure control in people with type 2 diabetes.
abstract: BACKGROUND
  Ambulatory blood pressure (BP) measurements (ABPM) predict health outcomes better than office BP, and are recommended for assessing BP control, particularly in high-risk patients. We assessed the performance of office BP in predicting optimal ambulatory BP control in sub-Saharan Africans with type 2 diabetes (T2DM).
  
  
  METHODS
  Participants were a random sample of 51 T2DM patients (25 men) drug-treated for hypertension, receiving care in a referral diabetes clinic in Yaounde, Cameroon. A quality control group included 46 non-diabetic individuals with hypertension. Targets for BP control were systolic (and diastolic) BP.
  
  
  RESULTS
  Mean age of diabetic participants was 60 years (standard deviation: 10) and median duration of diabetes was 6 years (min-max: 0-29). Correlation coefficients between each office-based variable and the 24-h ABPM equivalent (diabetic vs. non-diabetic participants) were 0.571 and 0.601 for systolic (SBP), 0.520 and 0.539 for diastolic (DBP), 0.631 and 0.549 for pulse pressure (PP), and 0.522 and 0.583 for mean arterial pressure (MAP). The c-statistic for the prediction of optimal ambulatory control from office-BP in diabetic participants was 0.717 for SBP, 0.494 for DBP, 0.712 for PP, 0.582 for MAP, and 0.721 for either SBP + DBP or PP + MAP. Equivalents in diabetes-free participants were 0.805, 0.763, 0.695, 0.801 and 0.813.
  
  
  CONCLUSIONS
  Office DBP was ineffective in discriminating optimal ambulatory BP control in diabetic patients, and did not improve predictions based on office SBP alone. Targeting ABPM to those T2DM patients who are already at optimal office-based SBP would likely be more cost effective in this setting.
authors.affiliation: South African Medical Research Council & University of Cape Town, Cape Town, South Africa.
authors.forename: Andre Pascal
authors.initials: AP
authors.lastname: Kengne
authors.affiliation: Diabetes and Endocrine service, Yaounde Central Hospital, Yaounde, Cameroon.
authors.forename: Christelle Nong
authors.initials: CN
authors.lastname: Libend
authors.affiliation: Service of Internal Medicine, General Hospital of Douala, Douala, & Buea faculty of Health Sciences, Buea, Cameroon.
authors.forename: Anastase
authors.initials: A
authors.lastname: Dzudie
authors.affiliation: Service of Medicine A, General Hospital of Yaounde, Yaounde, Cameroon.
authors.forename: Alain
authors.initials: A
authors.lastname: Menanga
authors.affiliation: Diabetes and Endocrine service, Yaounde Central Hospital, Yaounde, Cameroon.
authors.forename: Mesmin Yefou
authors.initials: MY
authors.lastname: Dehayem
authors.affiliation: Service of Medicine A, General Hospital of Yaounde, Yaounde, Cameroon.
authors.forename: Samuel
authors.initials: S
authors.lastname: Kingue
authors.affiliation: Diabetes and Endocrine service, Yaounde Central Hospital, Yaounde, Cameroon.
authors.forename: Eugene
authors.initials: E
authors.lastname: Sobngwi
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D001795:Blood Pressure Determination / Q000379:methods*; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods; D002163:Cameroon; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged
chemical_list: D000959:Antihypertensive Agents
keywords: Ambulatory blood pressure; Cameroon; diabetes mellitus; office blood pressure; prediction; sub-Saharan Africa
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