Masked hypertension in diabetes mellitus: Treatment Implications for Clinical Practice

Stanley S Franklin; Lutgarde Thijs; Yan Li; Tine W Hansen; José Boggia; Yanping Liu; Kei Asayama; Kristina Björklund-Bodegård; Takayoshi Ohkubo; Jørgen Jeppesen; Christian Torp-Pedersen; Eamon Dolan; Tatiana Kuznetsova; Katarzyna Stolarz-Skrzypek; Valérie Tikhonoff; Sofia Malyutina; Edoardo Casiglia; Yuri Nikitin; Lars Solskov Lind; Edgardo Sandoya; Kalina Kawecka-Jaszcz; Jan Filipovsky; Yutaka Imai; Jiguang Wang; Hans Ibsen; Eoin O'Brien; Jan A Staessen; International Database on Ambulatory blood pressure in Relation to Cardiovascular Outcomes Investigators

doi:10.1161/HYPERTENSIONAHA.111.00289

Masked hypertension in diabetes mellitus: Treatment Implications for Clinical Practice

Stanley S Franklin, Lutgarde Thijs, Yan Li, Tine W Hansen, José Boggia, Yanping Liu, Kei Asayama, Kristina Björklund-Bodegård, Takayoshi Ohkubo, Jørgen Jeppesen, Christian Torp-Pedersen, Eamon Dolan, Tatiana Kuznetsova, Katarzyna Stolarz-Skrzypek, Valérie Tikhonoff, Sofia Malyutina, Edoardo Casiglia, Yuri Nikitin, Lars Solskov Lind, Edgardo SandoyaKalina Kawecka-Jaszcz, Jan Filipovsky, Yutaka Imai, Jiguang Wang, Hans Ibsen, Eoin O'Brien, Jan A Staessen, International Database on Ambulatory blood pressure in Relation to Cardiovascular Outcomes Investigators

Institut for Klinisk Medicin

104 Citationer (Scopus)

Abstract

Although distinguishing features of masked hypertension in diabetics are well known, the significance of antihypertensive treatment on clinical practice decisions has not been fully explored. We analyzed 9691 subjects from the population-based 11-country International Database on Ambulatory Blood Pressure in Relation to Cardiovascular Outcomes. Prevalence of masked hypertension in untreated normotensive participants was higher (P<0.0001) among 229 diabetics (29.3%, n=67) than among 5486 nondiabetics (18.8%, n=1031). Over a median of 11.0 years of follow-up, the adjusted risk for a composite cardiovascular end point in untreated diabetic-masked hypertensives tended to be higher than in normotensives (hazard rate [HR], 1.96; 95% confidence interval [CI], 0.97-3.97; P=0.059), similar to untreated stage 1 hypertensives (HR, 1.07; CI, 0.58-1.98; P=0.82), but less than stage 2 hypertensives (HR, 0.53; CI, 0.29-0.99; P=0.048). In contrast, cardiovascular risk was not significantly different in antihypertensive-treated diabetic-masked hypertensives, as compared with the normotensive comparator group (HR, 1.13; CI, 0.54-2.35; P=0.75), stage 1 hypertensives (HR, 0.91; CI, 0.49-1.69; P=0.76), and stage 2 hypertensives (HR, 0.65; CI, 0.35-1.20; P=0.17). In the untreated diabetic-masked hypertensive population, mean conventional systolic/diastolic blood pressure was 129.2±8.0/76.0±7.3 mm Hg, and mean daytime systolic/diastolic blood pressure 141.5±9.1/83.7±6.5 mm Hg. In conclusion, masked hypertension occurred in 29% of untreated diabetics, had comparable cardiovascular risk as stage 1 hypertension, and would require considerable reduction in conventional blood pressure to reach daytime ambulatory treatment goal. Importantly, many hypertensive diabetics when receiving antihypertensive therapy can present with normalized conventional and elevated ambulatory blood pressure that mimics masked hypertension.

Originalsprog	Engelsk
Tidsskrift	Hypertension
Vol/bind	61
Udgave nummer	5
Sider (fra-til)	964-971
Antal sider	8
ISSN	0194-911X
DOI	https://doi.org/10.1161/HYPERTENSIONAHA.111.00289
Status	Udgivet - maj 2013

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10.1161/HYPERTENSIONAHA.111.00289

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Franklin, S. S., Thijs, L., Li, Y., Hansen, T. W., Boggia, J., Liu, Y., Asayama, K., Björklund-Bodegård, K., Ohkubo, T., Jeppesen, J., Torp-Pedersen, C., Dolan, E., Kuznetsova, T., Stolarz-Skrzypek, K., Tikhonoff, V., Malyutina, S., Casiglia, E., Nikitin, Y., Lind, L. S., ... Investigators, I. D. O. A. B. P. I. R. T. C. O. (2013). Masked hypertension in diabetes mellitus: Treatment Implications for Clinical Practice. Hypertension, 61(5), 964-971. https://doi.org/10.1161/HYPERTENSIONAHA.111.00289

Franklin, SS, Thijs, L, Li, Y, Hansen, TW, Boggia, J, Liu, Y, Asayama, K, Björklund-Bodegård, K, Ohkubo, T, Jeppesen, J, Torp-Pedersen, C, Dolan, E, Kuznetsova, T, Stolarz-Skrzypek, K, Tikhonoff, V, Malyutina, S, Casiglia, E, Nikitin, Y, Lind, LS, Sandoya, E, Kawecka-Jaszcz, K, Filipovsky, J, Imai, Y, Wang, J, Ibsen, H, O'Brien, E, Staessen, JA & Investigators, IDOABPIRTCO 2013, 'Masked hypertension in diabetes mellitus: Treatment Implications for Clinical Practice', Hypertension, bind 61, nr. 5, s. 964-971. https://doi.org/10.1161/HYPERTENSIONAHA.111.00289

@article{8b45b40f9d2e4074b9cc2f807f0aea25,

title = "Masked hypertension in diabetes mellitus: Treatment Implications for Clinical Practice",

abstract = "Although distinguishing features of masked hypertension in diabetics are well known, the significance of antihypertensive treatment on clinical practice decisions has not been fully explored. We analyzed 9691 subjects from the population-based 11-country International Database on Ambulatory Blood Pressure in Relation to Cardiovascular Outcomes. Prevalence of masked hypertension in untreated normotensive participants was higher (P<0.0001) among 229 diabetics (29.3%, n=67) than among 5486 nondiabetics (18.8%, n=1031). Over a median of 11.0 years of follow-up, the adjusted risk for a composite cardiovascular end point in untreated diabetic-masked hypertensives tended to be higher than in normotensives (hazard rate [HR], 1.96; 95% confidence interval [CI], 0.97-3.97; P=0.059), similar to untreated stage 1 hypertensives (HR, 1.07; CI, 0.58-1.98; P=0.82), but less than stage 2 hypertensives (HR, 0.53; CI, 0.29-0.99; P=0.048). In contrast, cardiovascular risk was not significantly different in antihypertensive-treated diabetic-masked hypertensives, as compared with the normotensive comparator group (HR, 1.13; CI, 0.54-2.35; P=0.75), stage 1 hypertensives (HR, 0.91; CI, 0.49-1.69; P=0.76), and stage 2 hypertensives (HR, 0.65; CI, 0.35-1.20; P=0.17). In the untreated diabetic-masked hypertensive population, mean conventional systolic/diastolic blood pressure was 129.2±8.0/76.0±7.3 mm Hg, and mean daytime systolic/diastolic blood pressure 141.5±9.1/83.7±6.5 mm Hg. In conclusion, masked hypertension occurred in 29% of untreated diabetics, had comparable cardiovascular risk as stage 1 hypertension, and would require considerable reduction in conventional blood pressure to reach daytime ambulatory treatment goal. Importantly, many hypertensive diabetics when receiving antihypertensive therapy can present with normalized conventional and elevated ambulatory blood pressure that mimics masked hypertension.",

author = "Franklin, {Stanley S} and Lutgarde Thijs and Yan Li and Hansen, {Tine W} and Jos{\'e} Boggia and Yanping Liu and Kei Asayama and Kristina Bj{\"o}rklund-Bodeg{\aa}rd and Takayoshi Ohkubo and J{\o}rgen Jeppesen and Christian Torp-Pedersen and Eamon Dolan and Tatiana Kuznetsova and Katarzyna Stolarz-Skrzypek and Val{\'e}rie Tikhonoff and Sofia Malyutina and Edoardo Casiglia and Yuri Nikitin and Lind, {Lars Solskov} and Edgardo Sandoya and Kalina Kawecka-Jaszcz and Jan Filipovsky and Yutaka Imai and Jiguang Wang and Hans Ibsen and Eoin O'Brien and Staessen, {Jan A} and Investigators, {International Database on Ambulatory blood pressure in Relation to Cardiovascular Outcomes}",

year = "2013",

month = may,

doi = "10.1161/HYPERTENSIONAHA.111.00289",

language = "English",

volume = "61",

pages = "964--971",

journal = "Hypertension",

issn = "0194-911X",

publisher = "Lippincott Williams & Wilkins",

number = "5",

}

TY - JOUR

T1 - Masked hypertension in diabetes mellitus

T2 - Treatment Implications for Clinical Practice

AU - Franklin, Stanley S

AU - Thijs, Lutgarde

AU - Li, Yan

AU - Hansen, Tine W

AU - Boggia, José

AU - Liu, Yanping

AU - Asayama, Kei

AU - Björklund-Bodegård, Kristina

AU - Ohkubo, Takayoshi

AU - Jeppesen, Jørgen

AU - Torp-Pedersen, Christian

AU - Dolan, Eamon

AU - Kuznetsova, Tatiana

AU - Stolarz-Skrzypek, Katarzyna

AU - Tikhonoff, Valérie

AU - Malyutina, Sofia

AU - Casiglia, Edoardo

AU - Nikitin, Yuri

AU - Lind, Lars Solskov

AU - Sandoya, Edgardo

AU - Kawecka-Jaszcz, Kalina

AU - Filipovsky, Jan

AU - Imai, Yutaka

AU - Wang, Jiguang

AU - Ibsen, Hans

AU - O'Brien, Eoin

AU - Staessen, Jan A

AU - Investigators, International Database on Ambulatory blood pressure in Relation to Cardiovascular Outcomes

PY - 2013/5

Y1 - 2013/5

N2 - Although distinguishing features of masked hypertension in diabetics are well known, the significance of antihypertensive treatment on clinical practice decisions has not been fully explored. We analyzed 9691 subjects from the population-based 11-country International Database on Ambulatory Blood Pressure in Relation to Cardiovascular Outcomes. Prevalence of masked hypertension in untreated normotensive participants was higher (P<0.0001) among 229 diabetics (29.3%, n=67) than among 5486 nondiabetics (18.8%, n=1031). Over a median of 11.0 years of follow-up, the adjusted risk for a composite cardiovascular end point in untreated diabetic-masked hypertensives tended to be higher than in normotensives (hazard rate [HR], 1.96; 95% confidence interval [CI], 0.97-3.97; P=0.059), similar to untreated stage 1 hypertensives (HR, 1.07; CI, 0.58-1.98; P=0.82), but less than stage 2 hypertensives (HR, 0.53; CI, 0.29-0.99; P=0.048). In contrast, cardiovascular risk was not significantly different in antihypertensive-treated diabetic-masked hypertensives, as compared with the normotensive comparator group (HR, 1.13; CI, 0.54-2.35; P=0.75), stage 1 hypertensives (HR, 0.91; CI, 0.49-1.69; P=0.76), and stage 2 hypertensives (HR, 0.65; CI, 0.35-1.20; P=0.17). In the untreated diabetic-masked hypertensive population, mean conventional systolic/diastolic blood pressure was 129.2±8.0/76.0±7.3 mm Hg, and mean daytime systolic/diastolic blood pressure 141.5±9.1/83.7±6.5 mm Hg. In conclusion, masked hypertension occurred in 29% of untreated diabetics, had comparable cardiovascular risk as stage 1 hypertension, and would require considerable reduction in conventional blood pressure to reach daytime ambulatory treatment goal. Importantly, many hypertensive diabetics when receiving antihypertensive therapy can present with normalized conventional and elevated ambulatory blood pressure that mimics masked hypertension.

AB - Although distinguishing features of masked hypertension in diabetics are well known, the significance of antihypertensive treatment on clinical practice decisions has not been fully explored. We analyzed 9691 subjects from the population-based 11-country International Database on Ambulatory Blood Pressure in Relation to Cardiovascular Outcomes. Prevalence of masked hypertension in untreated normotensive participants was higher (P<0.0001) among 229 diabetics (29.3%, n=67) than among 5486 nondiabetics (18.8%, n=1031). Over a median of 11.0 years of follow-up, the adjusted risk for a composite cardiovascular end point in untreated diabetic-masked hypertensives tended to be higher than in normotensives (hazard rate [HR], 1.96; 95% confidence interval [CI], 0.97-3.97; P=0.059), similar to untreated stage 1 hypertensives (HR, 1.07; CI, 0.58-1.98; P=0.82), but less than stage 2 hypertensives (HR, 0.53; CI, 0.29-0.99; P=0.048). In contrast, cardiovascular risk was not significantly different in antihypertensive-treated diabetic-masked hypertensives, as compared with the normotensive comparator group (HR, 1.13; CI, 0.54-2.35; P=0.75), stage 1 hypertensives (HR, 0.91; CI, 0.49-1.69; P=0.76), and stage 2 hypertensives (HR, 0.65; CI, 0.35-1.20; P=0.17). In the untreated diabetic-masked hypertensive population, mean conventional systolic/diastolic blood pressure was 129.2±8.0/76.0±7.3 mm Hg, and mean daytime systolic/diastolic blood pressure 141.5±9.1/83.7±6.5 mm Hg. In conclusion, masked hypertension occurred in 29% of untreated diabetics, had comparable cardiovascular risk as stage 1 hypertension, and would require considerable reduction in conventional blood pressure to reach daytime ambulatory treatment goal. Importantly, many hypertensive diabetics when receiving antihypertensive therapy can present with normalized conventional and elevated ambulatory blood pressure that mimics masked hypertension.

U2 - 10.1161/HYPERTENSIONAHA.111.00289

DO - 10.1161/HYPERTENSIONAHA.111.00289

M3 - Journal article

SN - 0194-911X

VL - 61

SP - 964

EP - 971

JO - Hypertension

JF - Hypertension

IS - 5

ER -

Masked hypertension in diabetes mellitus: Treatment Implications for Clinical Practice

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