Abstract 14379: Clinical Significance of Masked and White-coat Hypertension in Type 2 Diabetes - The J-HOP Study
Background: The clinical significance of masked hypertension (MH) and white-coat hypertension (WCH) in treated type 2 diabetes (T2DM) patients are not well established.
Objective: We tested the hypothesis that MH and WCH in T2DM are associated with higher cardiovascular risk than normotensive (NT) T2DM, compared to non-diabetic patients.
Methods: We enrolled 4311 patients who have at least one cardiovascular risk factor, and performed clinic and home BP monitoring. Home BP was calculated as the mean of morning and evening values for 14 days. The urinary albumin creatinine ratio (UACR) was measured as a surrogate marker of cardiovascular risk. Cutoff values of clinic BP 140/90 and home BP 135/85 mmHg (cutoff 1); and clinic BP 130/80 and home BP 125/75 mmHg (cutoff 2) were used to classify sustained hypertension (SH: both high), WCH (high clinic BP, normal home BP), MH (normal clinic BP, high home BP), and NT (both low). Logistic regression analyses were used for the likelihood of microalbuminuria (UACR ≧30mg/gcr) and macroalbuminuria (UACR ≧300mg/gcr).
Results: The mean age was 64.9±10.9 years; 47.0% were male; and 87.1% had hypertension. There were 1057 (24.5%) patients with diabetes, and 3254 (75.5%) without diabetes. When the group with NT was set as a reference using the cutoff 1, there were higher odds ratio (OR) for microalbuminuria in non-diabetic and T2DM patients (Figure ). For macroalbuminuria, only SH had higher OR in non-diabetes, but in T2DM, both MH and SH had significantly higher OR compared to the NT. When the parallel analyses were performed using the cutoff 2, these relationships got insignificant.
Conclusions: WCH and MH had higher impact of microalbuminuria than normotensive in patients with T2DM and non-diabetes. On the other hand, MH, but not WCH, had increased likelihood of having macroalbuminuria in T2DM. Home BP monitoring is useful for the risk stratification of hypertensive patients with type 2 diabetes.
- © 2013 by American Heart Association, Inc.