New diagnostics for hypertension in diabetes and the role of chronotherapy: a new perspective

Globally, diabetes has become one of the major causes of premature morbidity and mortality, and this is mainly attributable to the increased risk of cardiovascular (CV) disease. CV risk stratification is based on well-established risk factors including hypertension, diabetes, dyslipidaemia, smoking, age and sex. However, current assessment models are imperfect. Improved risk stratification may be achieved by the use of home and ambulatory blood pressure (BP) monitoring. Identification of new CV risk factors, which add prognostic information, may also improve risk stratification. Pulse wave velocity and central BP have been suggested as new parameters with independent prognostic ability. Moreover, treatment targets of hypertension are not met in many patients. Strategies to improve BP control include new ways of drug treatment, with chronotherapy offering a cost-free and simple approach. The present paper will review these issues with a specific focus on studies in diabetic patients.