Monitorização ambulatorial da pressão arterial e diabete melito tipo 2

Abstract

SummaryHypertension is one of the main risk factors for the onset and progression of chronic complications in type 2 diabetes mellitus (DM).Ambulatory blood pressure (BP) monitoring (ABPM) provides a better correlation with target organ lesions than BP obtained in the office. Furthermore, it allows the evaluation of distinct BP parameters such as the 24-h, daytime and nighttime systolic and diastolic BP means, BP loads and the absence of nocturnal drop of BP, as well as the identification of white-coat and masked hypertension.DM patients have higher daytime and nighttime BP means than non-DM patients. In addition, one third of normotensive type 2 DM patients have masked hypertension, which is associated with an increase in albuminuria and in left ventricle wall thickness. On the other hand, the prevalence and effect of white-coat hypertension in type 2 DM patients have not yet been properly evaluated. The absence of nocturnal drop of BP does not add information to the 24 h, daytime or nighttime BP measurements, but the nighttime BP means seem to be relevant in DM retinopathy.In conclusion, BP determination by ABPM allows better patient risk stratification for the development of DM chronic complications and is an essential instrument for effective BP control in these patients. Arterial pressure and diabetes mellitusType 2 diabetes mellitus (DM) is associated with the development of chronic microvascular and macrovascular complications with high rates of morbidity and mortality 1,2 . The classic and most analyzed risk factors for the development and progression of chronic DM complications are DM duration, hyperglycemia, arterial hypertension (AH), dyslipidemia, and smoking, besides genetic factors [3][4][5][6][7][8] . The treatment of hyperglycemia and SAH results in primary prevention and reduction of the progression of diabetic retinopathy (DR) and diabetic nephropathy (DN) 9,10

White-Coat Hypertension Should Not Be Treated in Subjects With Diabetes

“…An example could be the population-based PAMELA (Pressioni Arteriose Monitorate E Loro Associazioni) study, where higher ambulatory BP was associated with such abnormalities, as well as with a higher prevalence of diabetes (21). Similar findings appeared in studies of subjects with type 2 diabetes (4,22–24). Even slight BP elevation in high-risk subjects (those with diabetes) may have prognostic implications.…”

“…A similar conclusion was arrived at in a recent Brazilian study where masked hypertension was not only more prevalent (4), but also associated with a higher rate of target organ damage (5). …”

Unmasking masked hypertension: prevalence, clinical implications, diagnosis, correlates and future directions

“…Patients with diabetes have a higher prevalence of masked hypertension than patients without diabetes 17,19,20 . Among 7,826 subjects from the IDACO database not taking antihypertensive medications, the prevalence of masked hypertension (clinic BP < 140/90 mmHg and daytime ambulatory BP ≥135/85 mmHg) was higher in the clinic normotensive participants with diabetes (29.3%) than without diabetes (18.8%) 17 .…”

Nocturnal blood pressure fall as predictor of diabetic nephropathy in hypertensive patients with type 2 diabetes

“…Other conditions, such obstructive sleep apnea and renal failure with fluid retention might be involved [26]. Whatever its mechanisms might be, the increase of systolic nocturnal BP and or lack of normal nocturnal BP fall have been related to chronic complications in diabetic patients [27]. …”