Uncontrolled isolated office hypertension is associated with subclinical markers of cardiovascular disease in hypertensive type 2 diabetic patients

Abstract

Isolated office hypertension (IOH) has been associated with structural cardiac abnormalities; however, its relation to worse cardiovascular prognosis remains uncertain. Less is known regarding the consequences of uncontrolled IOH in treated hypertensives. The aim was to investigate whether uncontrolled IOH was independently associated with two subclinical markers of cardiovascular disease, aortic stiffness and left ventricular hypertrophy (LVH). Clinical laboratory and 24-h ambulatory blood pressure (BP) data were obtained in 523 hypertensive patients with type 2 diabetes. Controlled office-ambulatory hypertension was defined by office blood pressure o140/90 mm Hg and 24-h BP o130/80 mm Hg, whereas uncontrolled IOH by office blood pressureX140/90 mm Hg and 24-h BP o130/80 mm Hg. Arterial stiffness was assessed by carotid-femoral pulse wave velocity (PWV) and left ventricular mass index (LVMI) by echocardiography. Statistics included multivariate linear and logistic regressions. According to BP patterns, 152 patients (29.1%) had controlled office-ambulatory hypertension, and 172 (32.9%) had uncontrolled IOH. Patients with uncontrolled IOH had greater LVMI (62.0 ± 21.9 vs. 52.9 ± 17.0 g m À2.7 , Po0.001) and PWV (11.5 ± 2.4 vs. 10.2 ± 2.1 m s À1 , Po0.001) than those with controlled hypertension. On linear model, after adjustment for several potential confounders, patients with uncontrolled IOH persisted with higher PWV (P¼0.003) and LVMI (P¼0.015). On logistic regression, the presence of uncontrolled IOH was independently associated with 2.7-fold (95% CI: 1.3-5.5) and 2.1-fold (95% CI: 1.1-4.0) higher risks of having increased aortic stiffness and LVH, respectively. In conclusion, uncontrolled IOH is associated with increased aortic stiffness and LVH in hypertensive type 2 diabetic patients. This may be a link to augmented cardiovascular risk. Keywords: aortic stiffness; left ventricular hypertrophy; type 2 diabetes; uncontrolled isolated office hypertension INTRODUCTION Some studies showed a better cardiovascular prognosis for isolated office hypertension patients (white-coat hypertension) than for those with sustained hypertension; 1-3 however, its prognostic significance in relation to sustained normal blood pressure (BP) remains controversial. 1,4-6 Nonetheless, isolated office hypertension has been associated with structural cardiac abnormalities in general population studies, mainly increased left ventricular mass, 7-9 which is a known marker of increased cardiovascular risk. 10 In normoalbuminuric type 2 diabetic patients, the prevalence of isolated office hypertension appears to be identical to hypertensive nondiabetic individuals, 11 and the presence of isolated office hypertension has been associated with macroalbuminuria and diabetic retinopathy. 12 However, less knowledge is available regarding the importance of uncontrolled isolated office hypertension (the white-coat effect) in treated hypertensives in relation to those with sustained controlled office and ambulatory hypertension.