Abstract 5146: Pre-diabetes is Associated With Masked Hypertension
Background: Masked hypertension, a condition where awake ambulatory blood pressure (BP) is elevated (≥135/85 mmHg) while office BP is within the normal range (<140/90 mmHg), is associated with an increased risk of cardiovascular events; however, mechanisms causing masked hypertension remain unclear. We evaluated whether increased glucose within the non-diabetic range (fasting glucose <126 mg/dl) and/or presence of pre-diabetes (fasting glucose 100 –125 mg/dl) is associated with masked hypertension.
Methods: We performed office BP measurements (3 readings/visit, at 3 visits), a single 24-hr ambulatory BP (ABP) monitoring and a fasting blood glucose test in 475 healthy, employed volunteers who did not have either office hypertension or diabetes.
Results: The average age was 44.7±11.1 years (male; 37.5%). The subjects with masked hypertension (N=76) were older (47.5±8.9 vs. 44.2±10.2 years, P=0.009), more likely to be male (53.9 vs. 34.3%, P=0.001) and pre-diabetic (32.9 vs. 11.8 %, P<0.001); they had higher fasting glucose (94±12 vs. 88±11 mg/dl, P<0.001), body mass index (29.0±5.7 vs. 27.1±5.2 kg/m2, P=0.004), serum creatinine (0.87±0.15 vs. 0.82±0.15 mg/dl, P=0.009), office SBP (123±8 vs. 112±9 mmHg, P<0.001) and office DBP (81±5 vs. 73±7 mmHg, P<0.001) than those with normal ABP (<135/85 mmHg). In a logistic regression analysis, fasting glucose level was significantly associated with masked hypertension [odds ratio (OR) per 10 mg/dl, 1.35, 95% confidence interval (CI) 1.01–1.80, P=0.044], controlling for the confounding factors. In a parallel analysis, presence of pre-diabetes was also associated with masked hypertension (OR=2.68, 95%CI 1.42–5.09, P=0.002). Prevalence of masked hypertension was 51.2% among those with both pre-hypertension and pre-diabetes, 34.5% among those with pre-hypertension alone, 10.3% among those with pre-diabetes alone, and 3.8% among those without either of them.
Conclusion: Both pre-diabetes status and fasting glucose (measured on a continuum) in non-diabetic individuals are associated with presence of masked hypertension, suggesting that ambulatory BP monitoring can improve CV risk stratification (over and above office BP) in persons with pre-diabetes in addition to pre-hypertension.