Nephrology Service, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain.
Hypertens Res. 2011 Nov;34(11):1185-9. doi: 10.1038/hr.2011.100. Epub 2011 Aug 11.
Our aim was to assess the ambulatory blood pressure monitoring (ABPM) characteristics or patterns in hypertensive patients with diabetes compared with non-diabetic hypertensives. We performed a cross-sectional analysis of a 68,045 patient database from the Spanish Society of Hypertension ABPM Registry, a nation-wide network of >1200 primary-care physicians performing ABPM under standardized conditions in daily practice. We identified 12,600 (18.5%) hypertensive patients with diabetes. When compared with patients without diabetes, diabetic hypertensives exhibited higher systolic blood pressure (BP) levels in every ABPM period (daytime 135.4 vs. 131.8, and nighttime 126.0 vs. 121.0 mm Hg, P<0.001 for both) despite they were receiving more antihypertensive drugs (mean number 1.71 vs. 1.23, P<0.001). Consequently, diabetic patients suffered from lack of control of BP more frequently than non-diabetic subjects particularly during the night (65.5% vs. 57.4%, P<0.001). Prevalence of a non-dipping BP profile (64.2% vs. 51.6%, P<0.001) was higher in diabetic patients. In the other hand, prevalence of 'white-coat' hypertension in diabetic patients was 33.0%. We conclude that there was a remarkably high prevalence of alterations in ABPM in patients with diabetes. Abnormalities in systolic BP, particularly during the night, and in circadian BP pattern could be linked with the excess of BP-related cardiovascular risk of diabetes. A wider use of ABPM in diabetic patients should be considered.
我们旨在评估与非糖尿病高血压患者相比，糖尿病合并高血压患者的动态血压监测（ABPM）特征或模式。我们对西班牙高血压学会 ABPM 登记处的 68045 名患者数据库进行了横断面分析，该登记处是一个全国性的网络，由 1200 多名初级保健医生组成，在日常实践中按照标准化条件进行 ABPM。我们确定了 12600 名（18.5%）患有糖尿病的高血压患者。与没有糖尿病的患者相比，尽管糖尿病高血压患者接受了更多的降压药物（平均数量为 1.71 比 1.23，P<0.001），但他们在 ABPM 的每个时间段（白天 135.4 比 131.8，夜间 126.0 比 121.0mmHg，均 P<0.001）的收缩压水平更高。因此，与非糖尿病患者相比，糖尿病患者的血压控制不良更为频繁，尤其是在夜间（65.5%比 57.4%，P<0.001）。非杓型血压模式（64.2%比 51.6%，P<0.001）在糖尿病患者中更为常见。另一方面，糖尿病患者的“白大衣”高血压患病率为 33.0%。我们得出结论，糖尿病患者的 ABPM 异常发生率显著较高。收缩压异常，尤其是夜间和昼夜血压模式异常，可能与糖尿病引起的血压相关心血管风险增加有关。应考虑在糖尿病患者中更广泛地使用 ABPM。
