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Increased Prevalence of Masked Blood Pressure Elevations in Treated Diabetic Subjects

Iddo Z. Ben-Dov, MD; Drori Ben-Ishay, MD; Judith Mekler, MSc; Liora Ben-Arie; Michael Bursztyn, MD
Arch Intern Med. 2007;167(19):2139-2142. doi:10.1001/archinte.167.19.2139.
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Hypertensive-type target organ damage is increased in patients with diabetes mellitus compared with blood pressure–matched individuals with euglycemia.18 Hyperglycemia and accompanying metabolic abnormalities partly explain this gap.9 Another possible explanation is a lower sensitivity of clinic blood pressure measurements in diabetic patients.10,11 Failure of clinic measurements to detect out-of-office elevated blood pressure results in the recently characterized entity of “masked hypertension,” also known as isolated ambulatory hypertension and reverse white-coat hypertension, in which “true” blood pressure is underestimated and thus undertreated (among subjects with treated hypertension, these terms refer to masked uncontrolled hypertension12). The prognostic consequences of masked hypertension are similar to those of sustained hypertension.13,14 Several studies have documented a higher level of target organ damage among subjects with treated hypertension and “masked” blood pressure elevation, namely, misleadingly controlled clinic blood pressure.1518

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The percentage of subjects in the case-control study with awake hypertension (HTN) (≥135/85 mm Hg) vs clinic blood pressure category: normal (<130/80 mm Hg), high-normal (130-139/80-89 mm Hg), and clinic HTN (≥140/90 mm Hg). Black bars represent control (nondiabetic) subjects and gray bars, subjects with treated diabetes mellitus. Across the clinic blood pressure categories, the prevalence of awake HTN is higher in diabetic subjects (P = .01, Cochran's χ2). + indicates subjects with treated diabetes; and −, subjects without diabetes.

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