Mohd Rafi Mir

Mohd Rafi Mir

Physician Health Services Kashmir , India

Title: Hypertensive phenotypes and pattern of ambulatory blood pressure in patients of diabetes mellitus of Kashmir valley


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.


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.