Study Of Masked Hypertension On The Target Organ Damage Of Patients With Type 2 Diabetes

Background and purpose:Recent years,with the improvement of living condition,change of lifestyle and progress of aging,the prevalence of diabetes has raised rapidly in China.Diabetes has become a common chronic disease threatening human's health.Diabetes can cause a series of chronic complications such as diabetic cardiomyopathy,diabetic nephropathy,diabetic retinopathy and so on,influencing the living quality and increasing the financial burden on patients.Likewise,hypertension is a very common chronic disease which is harm to human's health.Hypertension can cause heart failure,myocardial infarction,stroke,kidney damage,and it's the main risk factor of cardiovascular and cerebrovascular diseases.Diabetes and hypertension are often in combination,leading to aggravation of target organ damage.Masked hypertension(MH)is defined as a clinical condition in which a patient 's office blood pressure(BP)level is normal but ambulatory or home BP readings are in the hypertensive range.Because of its normal clinical blood pressure(CBP),MH is always be ignored by both doctors and patients.Lately some foreign scholars have pay attention to MH,demonstrated the target organ damage of MH.Individuals with MH have been shown to have increased carotid intima-media thickness,more left ventricle hypertrophy,higher cystatin-C level,lower glomerular filtration rate and maybe greater stroke morbidity.However,less is known about the damage of MH to patients with type 2 diabetes mellitus(T2DM),only a few abroad researches reported that MH aggravates cardiovascular risk and kidney damage to patients with T2 DM.While the number of cases in above studies is small,and it is lack of studies focusing on the morbidity and target damage of MH to Chinese type 2 diabetic patients.Therefore,we performed the current study to examine the prevalence and severity of target organ damage of MH in hospitalized diabetic patients.Subjects:131 diabetic patients with normal clinical blood pressure(male,n=83;female,n=48,aged 20 to 84 years old,mean age 55.26±12.39 years old)admitted in the deparment of Hypertension and Endocrinology in Third Affiliated Hospital of Third Military Medical University were enrolled between Mar.2015 and Mar.2016.All patients was divided to MH group(n=71)and normotensive(NT)group(n=60)by the result of 24-h ambulatory blood pressure monitoring(ABPM).Methods:Diagnosis criteria of T2 DM is according to Chinese Guideline of Diagnosis and Prevention of Type 2 Diabetes Mellitus 2013: symptoms including polydipsia,polyphagia,polyuria,weight loss and other symptoms combined with random blood glucose ?11.1mmol/L,or with morning fasting plasma glucose(FPG)?7.0mmol / L,or with 2h blood glucose after oral glucose tolerance test(OGTT)?11.1mmol / L.Diagnosis criteria of MH is according to European Society of Hypertension Practice Guidelines for Ambulatory Blood Pressure Monitoring: CBP<140/90 mm Hg,and the mean daily ambulatory blood pressure?135/85 mmHg or and mean night ambulatory blood pressure?120/70 mm Hg or and 24 h mean ambulatory blood pressure?130/80 mm Hg.Collect patients' biochemical indexes,including blood routine examination,liver function,renal function,lipid profile,FPG,glycosylated hemoglobin(Hb A1c),24 h urinary biochemical indicators,24 h urinary micro total protein(M-TP).Measure and record CBP including systolic blood pressure(SBP)and diastolic blood pressure(DBP)of all patients,entire subjects underwent 24h-ABPM,ultrasonic cardiogram and carotid ultrasonography.Inclusion criteria: hospitalized patients diagnosed T2 DM according to above-mentioned standard,with normal CBP,unlimited age and unlimited gender.Exclusion criteria: type 1 diabetes mellitus,gestational diabetes mellitus,specific types of diabetes,CBP?140/90 mm Hg,acute complications of diabetes mellitus,previous cardiovascular disease,previous kidney disease or renal dysfunction,previous liver disease,using diuretics or other specific drugs.All data were analyzed using SPSS 19.0 software analysis.Student 's t test or X2 tests were used to compare clinical and laboratorial data.Data followed the normal distribution expressed as the means±SD,data not followed the normal distribution expressed as median [range].Regressions were performed to test risk factors.P values <0.05(two tailed)were considered to be significant.Results:1.Prevalence of MH in T2 DM patients is 53.4%,no significant differences were found in the prevalence of MH in males and females(55.4% vs 50%,P>0.05).2.Body mass index(BMI)(24.72 ± 3.12 vs 23.67 ± 2.89,P<0.05)and waist circumference(WC)(86.83±9.33 vs 82.72±8.11,P<0.05)of MH group were significantly bigger than NT group.3.Compared with NT group,patients in MH group have significantly higher interventricular septal thickness(IVST),left ventricular posterior wall thickness(LVPWT)and left ventricular mass index(LVMI)(P<0.01 or P<0.05).Only IVST of MH patients is bigger than it in NT group in male subjects(P<0.01).Liner regression analysis manifests that mean SBP and age are significantly risk factors associated with the ventricular remodeling(P<0.01).4.In overall subjects or in female patients,the UAER and M-TP in MH group is higher than NT group(P<0.01 or P<0.05).In overall subjects or in male patients,the prevalence of abnormal UAER and microalbuminuria in MH group is higher than NT group(P<0.01 or P<0.05).Logistic regression analysis showed that MH is the risk factor of abnormal UAER in total subjects,duration of diabetes and MH are risk factors in male patients(P<0.05).5.Two groups of patients were not significantly different with regard to carotid intima-media thickness(IMT)and prevalence of carotid plaque(P>0.05).In regression analyses,age,smoking and nighttime BP are associated with IMT in total subjects,age is associated with IMT in males or females(P<0.05).Age and ambulatory SBP are independently associated with carotid plaque in total or male patients(P<0.05).Age is associated with carotid plaque in females(P<0.05).Conclusion:1.Prevalence of MH is high in diabetic patients,24 h ABPM should be recommended in diabetic patients whose clinic BP is normal.2.Diabetic patients with MH showed evidence of cardiac damage,increasing in LVMI,and this kind of affection is more obvious in females.The damage to heart of MH is associated with daytime SBP and age.3.MH aggravates kidney damage of diabetic patients,increases UAER and prevalence of abnormal UAER of diabetics,duration of diabetes and MH are independently associated with abnormal UAER.4.Compared to T2 DM patients,IMT and prevalence of carotid plaque of diabetic patients with MH were not significantly different.Age,smoking and nighttime BP are associated with IMT.Age and ambulatory BP are associated with the prevalence of carotid plaque.