A STUDY OF AMBULATORY BLOOD PRESSURE MONITORING PARAMETERS IN HYPERTENSIVE PATIENTS WITH AND WITHOUT DIABETES MELLITUS

Abstract

BACKGROUND - Hypertension is a leading risk factor for many life threatening conditions. Large segments of the hypertensive population are untreated or inadequately treated and are prone to develop stroke, myocardial infarction or peripheral arterial diseases. When diabetes co-exists with hypertension the cardiovascular morbidity becomes magnified. Ambulatory blood pressure monitoring (ABPM) parameters has been shown to correlate more closely than office-measured BP with surrogate markers of end-organ damage, thus optimizing treatment and improving patient outcome.
OBJECTIVE - 1. To correlate between the ambulatory blood pressure patterns in hypertensive patients with and without type 2 diabetes melitus. 2.To correlate between ambulatory blood pressure patterns and presence of left ventricular hypertrophy in
hypertensive patients.
METHODOLOGY - Our study was a cross-sectional case control study conducted in K R Hospital attached to Mysuru Medical College, Department of Medicine, from Jan 2019 to June 2020. The study included 120 hypertensive patients of which 59 patients had diabetes
and 61 patients were non- diabetic. Their office BP values were recorded as the mean of three consecutive measurements. Ambulatory BP was recorded over 24 hours. They were subjected to 2D echo to assess end organ damage.
RESULTS - Our study showed that among 120 hypertensive patients 76 patients had uncontrolled mean ABPM values whereas 85 patients had nocturnal hypertension. Circadian ABPM values showed 45% patients were dippers and 38.3% of patients were found to be non-dippers. But among the diabetes group, 32.2% patients were dippers, whereas 44.1% of patients were found to be non-dippers. ABPM values were higher in patients with left ventricular hypertrophy (LVH). CONCLUSION - Diabetic patients with hypertension had significant alterations in the circadian ABPM patterns with a characteristic blunting of nocturnal dipping. ABPM values showed better correlation with the presence of end organ damage. This validates the use of ABPM in all diabetic patients