Ambulatory Blood-Pressure And Risk Of Cardiovascular-Disease In Type-II Diabetes-Mellitus

In order to determine the prognostic significance of ambulatory blood pressure in subjects with coexistence of essential hypertension and Type II diabetes, rye followed for up to 7.5 years (mean: 3.2) 106 hypertensive and 29 normotensive subjects with Type II diabetes and 1,080 hypertensive and 176 normotensive control subjects without diabetes. Ah subjects had a base line off-therapy 24-hour non invasive ambulatory blood pressure monitoring. Antihypertensive therapy was based on clinic blood pressure. The main outcome measure was the combined number of fatal and non-fatal cardiovascular morbid events during follow-up. white-coat and ambulatory hypertension were defined by normal and abnormal values, respectively, of daytime ambulatory blood pressure in clinically hypertensive subjects. A nocturnal decline in systolic and diastolic blood pressure by less than 10% defined non-dippers. In a Cox proportional hazard model, diabetes was a strong independent predictor of cardiovascular morbidity (relative risk: 2.02, 95% confidence intervals: 1.3 to 3.2). Among diabetics, the rate of cardiovascular morbid events per 100 patient-years was 2.0 in the normotensive group, 2.06 in the group with white-coat hypertension (p=NS vs the normotensive group) and 7.06 in the group with ambulatory hypertension (p<0.001 vs the former groups). Corresponding figures in non-diabetics were 0.1, 0.3 and 2.2%, respectively (similar statistical significance of differences between the groups as in the diabetic group). Among diabetics, the rate of cardiovascular morbid events per 100 patient-years in the subset with ambulatory hypertension was higher in non dippers than in dippers in women (9.2 vs 3.6, p<0.001), but not in men (6.7 vs 7.8, p<NS). In conclusion, Type II diabetes is a strong independent predictor of cardiovascular morbidity in subjects with essential hypertension and its predictive role persists after adjustment for ambulatory blood pressure. In Type II diabetes, cardiovascular risk: associated with hypertension is not increased in subjects with normal daytime ambulatory blood pressure (white-coat hypertension), and the adverse prognostic significance of a blunted or absent nocturnal reduction in blood pressure is limited to the female gender.