Clinical Application of a Complex of Blood Pressure Profile, Arterial Stiffness and Albuminuria for Cardiorenal Risk Assessment in DiabeticPatients

摘要

In modern epidemiology, risk assessment is a crucial step in diabetes care. Clinic blood pressurereading though is not a good measurement for this purpose since both uncontrolled hypertension and white coathypertension (WCH) are frequent among patients with diabetes mellitus (DM). Given the problems with clinicalapplication of ambulatory blood pressure monitoring (ABPM), in this study we evaluated clinical utility of home selfmeasurement (HSM) with a wrist-cuff device in DM patients with hypertension to make a BP profile. Also, the clinicalapplication of a complex of arterial study, albuminuria and blood pressure profile, in DM risk assessment wasinvestigated. Methods and Materials: Seventy-eight adult DM patients with labile or uncontrolled hypertension wererandomly assigned to 24 hour ABPM or HSM for 4 consecutive days and their BP profiles were evaluated in conjunctionwith an assessment of arterial stiffness and renal function as well as lipid profile. Results: The two groups were ofcomparable age, gender, BP, DM duration and control, smoking, lipids, renal function, arterial compliance andantihypertensive medication use. ABPM detected 33% WCH and 17.6% eveningight-time dipping, compared to 32%and 16% respectively for HSM, with overlapping 95% confidence intervals for day versus night BP regressioncoefficients. WCH patients had more compliant arteries as well as less albuminuria compared to the sustainedhypertensive group. Conclusion: A complex of BP profile (by either ABPM or HSM), arterial compliance andalbuminuria is a reliable and economical alternative to current methods for risk assessment in hypertensive diabeticpatients.