(Hypertension. 1995;26:1093-1099.)
© 1995 American Heart Association, Inc.
Articles |
Antihypertensive Treatment Efficacy in Type II Diabetes Mellitus
Dissociation Between Casual and 24-Hour Ambulatory Blood Pressure
From the Division of Internal Medicine, "La Paz" University Hospital (J.G.P.); the Division of Nephrology, "Doce de Octubre" University Hospital (L.M.R.); and the Medical Department of SmithKline Beecham Pharmaceuticals (R.O.). Other principal investigators who contributed to the study are listed in "Acknowledgments."
Correspondence to Dr Juan García Puig, Costa Brava, 23, 3° D, 28034 Madrid, Spain.
Abstract Whole-day ambulatory blood pressure monitoring
is used to confirm the diagnosis of hypertension and assess the
response to antihypertensive therapy. Neither of these has been applied
to patients with type II diabetes mellitus, in whom it has been
proposed that the desirable blood pressure should be lower than in
nondiabetics. This multicenter study was designed to examine
whether there are differences in the efficacy of a first-line
antihypertensive drug when assessed by casual and ambulatory blood
pressure determinations in patients with type II diabetes mellitus in
whom 24-hour ambulatory monitoring confirms or fails to confirm the
diagnosis of hypertension. Forty-three patients (mean age, 57.7
years) with stable type II diabetes mellitus and mild hypertension
(casual diastolic pressure, 90 to 104 mm Hg on at least
two visits) were treated with an angiotensin-converting
enzyme inhibitor (benazepril, 10 to 20 mg, once a day) for
8 weeks. Antihypertensive drug efficacy was assessed by casual (trough)
and 24-hour ambulatory blood pressure monitoring. Diabetic patients
were classified as nonconfirmed hypertensive if the mean 24-hour
ambulatory diastolic pressure was below 85 mm Hg.
Antihypertensive treatment significantly decreased both
systolic and diastolic pressures when determined by
either casual measurement (from a mean of 162.7/98.0 to 153.9/89.2
mm Hg; P<.001) or ambulatory monitoring (from a mean of
143.1/84.4 to 137.0/81.5 mm Hg; P<.05). Twenty-one
patients (49%) were classified as confirmed hypertensive and 22 as
nonconfirmed hypertensive. In confirmed hypertensive patients
benazepril significantly reduced systolic and
diastolic pressures when assessed by either casual or
24-hour ambulatory monitoring. In contrast, in nonconfirmed
hypertensive patients benazepril significantly decreased casual
diastolic pressure (mean decrease, 10.0 mm Hg) but did not
substantially modify 24-hour ambulatory diastolic pressure
(mean decrease, 1.3 mm Hg; P<.001). At the end of
antihypertensive therapy the number of patients with
diastolic pressure equal to, above, or below 90 mm Hg was
remarkably different when assessed by casual versus 24-hour ambulatory
determinations (
, 0.348; 95% confidence interval, -0.020 to
0.716; P>.1). The results indicate that whole-day
ambulatory blood pressure monitoring identifies a substantial number of
type II diabetic patients with nonconfirmed hypertension. In these
patients the discrepancy in diastolic pressure reduction
between casual and 24-hour ambulatory monitoring suggests that the
method of blood pressure assessment is important when evaluating
antihypertensive drug efficacy.
Key Words: hypertension, arterial • diabetes mellitus • angiotensin-converting enzyme inhibitors • blood pressure monitoring, ambulatory
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