Masked hypertension, nocturnal blood pressure and retinopathy in normotensive patients with type 1 diabetes

Rodrigues, Ticiana C.; Canani, Luis Henrique; Viatroski, Rafaela S.; Hoffmann, Luciana H.; Esteves, Jorge F.; Gross, Jorge L.

doi:10.1016/j.diabres.2009.10.016

« Previous Next »Diabetes Research and Clinical Practice
Volume 87, Issue 2 , Pages 240-245, February 2010

Masked hypertension, nocturnal blood pressure and retinopathy in normotensive patients with type 1 diabetes

Ticiana C. Rodrigues
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Corresponding author at: Serviço de Endocrinologia do Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, Prédio 12, 4° andar, 90035-003 Porto Alegre, RS, Brazil. Tel.: +55 51 2101 8127; fax: +55 51 2101 8777.
Luis Henrique Canani
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
Rafaela S. Viatroski
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
Luciana H. Hoffmann
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
Jorge F. Esteves
- Ophthalmology Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
Jorge L. Gross
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil

Received 27 April 2009; received in revised form 18 September 2009; accepted 26 October 2009. published online 19 November 2009.

Abstract

Aim

To analyze the prevalence of masked hypertension and its possible association with microvascular complications in patients with type 1 diabetes (T1D).

Methods

A cross-sectional study was conducted in 188 consecutive normotensive patients at the office with T1D without renal replacement therapy or previous renal transplant. All patients were assessed regarding the presence of diabetic retinopathy (DR) (direct and indirect fundoscopy), urinary albumin excretion rate (immunoturbidimetry), and ambulatory blood pressure monitoring (ABPM) (Spacelabs 90207).

Results

Masked hypertension was observed in 14 (13.6%) out of 103 clinical normotensive patients and in 7.4% of the entire cohort. Twenty-three percent of patients with clinical normotension had masked nocturnal hypertension. DR was associated with night systolic and diastolic BP [OR of each 5mmHg change 1.41 (95%CI: 1.09–1.83, P=0.009) and 1.40 (95%CI: 1.02–1.93, P=0.04), respectively] and with masked nocturnal hypertension [OR: 3.23 (95%CI: 1.29–8.11, P=0.01)].

Conclusions

In T1D patients with clinic BP<130/80mmHg, masked hypertension and especially masked nocturnal hypertension are present. Normotensive patients with nocturnal BP>120/70mmHg have higher presence of DR, and only will be identified through ABPM.

Keywords: Type 1 diabetes, Ambulatory blood pressure monitoring, Masked hypertension, Diabetic retinopathy