Clinical Application of a Complex of Blood Pressure Profile, Arterial Stiffness and Albuminuria for Cardiorenal Risk Assessment in Diabetic Patients

Abstract

Background: In modern epidemiology, risk assessment is a crucial step in diabetes care. Clinic blood pressure reading though is not a good measurement for this purpose since both uncontrolled hypertension and white coat hypertension (WCH) are frequent among patients with diabetes mellitus (DM). Given the problems with clinical application of ambulatory blood pressure monitoring (ABPM), in this study we evaluated clinical utility of home self measurement (HSM) with a wrist-cuff device in DM patients with hypertension to make a BP profile. Also, the clinical application of a complex of arterial study, albuminuria and blood pressure profile, in DM risk assessment was investigated. Methods and Materials: Seventy-eight adult DM patients with labile or uncontrolled hypertension were randomly assigned to 24 hour ABPM or HSM for 4 consecutive days and their BP profiles were evaluated in conjunction with an assessment of arterial stiffness and renal function as well as lipid profile. Results: The two groups were of comparable age, gender, BP, DM duration and control, smoking, lipids, renal function, arterial compliance and antihypertensive medication use. ABPM detected 33% WCH and 17.6% evening/night-time dipping, compared to 32% and 16% respectively for HSM, with overlapping 95% confidence intervals for day versus night BP regression coefficients. WCH patients had more compliant arteries as well as less albuminuria compared to the sustained hypertensive group. Conclusion: A complex of BP profile (by either ABPM or HSM), arterial compliance and albuminuria is a reliable and economical alternative to current methods for risk assessment in hypertensive diabetic patients.