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Mohd Rafi Mir
Physician Health Services Kashmir , IndiaTitle: Hypertensive phenotypes and pattern of ambulatory blood pressure in patients of diabetes mellitus of Kashmir valley
Abstract
Some patients of
diabetes mellitus (DM) who are normotensive or have controlled blood pressure
(BP) on office BP measurement (OBPM) may be having hypertension or uncontrolled
blood pressure on ambulatory blood pressure monitoring (ABPM).We conducted an observational
study to compare OBPM with ABPM and thus determine hypertensive phenotypes like
masked hypertension (MH) and white coat hypertension and pattern of blood
pressure in diabetic patients of our population.Two hundred patients of DM with
or without hypertension were included in this study, of whom 32 were
normotensives, 46 were hypertensives controlled on anti-hypertensive treatment,
22 were hypertensives not on anti?hypertensive treatment, and 100 were
hypertensives uncontrolled on anti?hypertensive treatment.Among 32 normotensive
diabetics, 17 (53%) patients had MH on ABPM. Out of these 32 normotensive
patients, 7 (21.8%) had isolated nocturnal hypertension, 3 (9.3%) had isolated
day?time hypertension and 7 (21.8%) had day?time and nocturnal hypertension.Non?dipping
pattern was found in 53% of patients of masked hypertension.
Out of 46
hypertensive diabetics with controlled OBPM on anti-hypertensive treatment, 26
(56.5%) had masked uncontrolled hypertension on ABPM. Out of 22 diabetics with
treatment naive hypertension, 7 (32%) were found to have white coat
hypertension on ABPM. Fifteen (15%) patients out of 100 hypertensive diabetics
with uncontrolled OBPM despite on anti?hypertensive were found to have white
coat effect on ABPM.Non?dipping pattern was significantly associated with
longer duration of diabetes (?120 months), retinopathy and neuropathy. To rely
exclusively on OBPM to diagnose hypertension and monitor blood pressure may
underestimate the CVD risk especially in diabetics. ABPM is a tool that may
help clinicians in starting anti-hypertensive treatment appropriately, avoiding
unnecessary anti?hypertensive treatment and/or withdrawing anti?hypertensive
treatment as indicated.
Biography
Mohammad Rafi Mir completed his M.D in
internal medicine from Sher-I-kashmir Institute Of Medical Sciences in 2020 and
is presently working as a primary care physician in directorate of health
services Kashmir.