Elevated ambulatory pulse pressure in hypertensive patients with type 2 diabetes mellitus

Increased pulse pressure (PP) is an independent marker of cardiovascular risk, mainly for myocardial infarction, congestive heart failure, and cardiovascular deaths. Moreover, reduced circadian blood pressure (BP) variation is a potential risk factor for the development of diabetic complications, as patients with type 2 diabetes mellitus (DM) show a progressive loss of nocturnal BP decline. Accordingly, we aimed to compare the circadian pattern of ambulatory BP variability between hypertensive patients with and without DM. We analyzed 2,756 BP profiles sampled from 1,418 patients (234 complicated with DM) with grade 1–2 hypertension (641 mean), 52.6±13.8 years of age. BP was measured by ambulatory monitoring (ABPM) at 20-min intervals from 07:00 to 23:00 hours and at 30-min intervals at night for 48 consecutive hours. Physical activity was simultaneously monitored every minute by wrist actigraphy, and the information used to determine diurnal and nocturnal means of BP for each patient according to individual resting time. Circadian parameters established by population multiple-component analysis were compared between patients with and without DM by nonparametric testing. Patients with DM, either untreated or evaluated under antihypertensive medication, are characterized by a significant increase in systolic BP, mainly during nocturnal resting hours, as compared to hypertensive patients without DM. The nocturnal mean of diastolic BP was, however, similar between groups, while the diurnal mean was significantly reduced in DM. Accordingly, there was a highly significant increase in PP across the 24 hours in both untreated (5.6 mm Hg in 24-hour mean, P<0.001) and treated patients with DM (6.4 mm Hg, P<0.001), as compared to patients without DM. Results from this study on hypertensive patients evaluated by 48-hour continuous ABPM and with nocturnal BP mean calculated individually according to actual resting time determined by actigraphy, indicates a highly significant increase of PP in patients with DM. Results also corroborate the significant reduction in day/night variation of systolic and diastolic BP in DM, reflecting a higher tendency towards a nondipper profile among patients with DM. The elevation in PP and the lack of a proper nocturnal decline in BP should be taking into account for the treatment of hypertensive patients with DM. Am J Hypertens (2004) 17, 214A–214A; doi: 10.1016/j.amjhyper.2004.03.571