Several ambulatory blood pressure monitoring (ABPM) phenotypes including masked hypertension are associated with an increased risk for cardiovascular disease (CVD). Diabetes is associated with CVD risk as well as a higher prevalence of hypertension. However, little is known about whether ABPM phenotypes differ between individuals with versus without diabetes. We evaluated the association between diabetes and ABPM phenotypes including clinic hypertension, awake hypertension, sustained hypertension, nocturnal hypertension, non-dipping pattern, white coat hypertension, and masked hypertension in the Jackson Heart Study (JHS). Baseline data collection included two clinic blood pressure measurements using standardized protocols. ABPM measurements were taken in the 24 hours following the baseline visit. Diabetes was defined as fasting glucose ≥126 mg/dL, hemoglobin A1c ≥6.5%, or use of diabetes medications. Of the 1,032 JHS participants with valid ABPM data (67.7% female, mean age 59.2 years), 253 (24.5%) had diabetes. The prevalence of clinic hypertension was similar for participants with and without diabetes (Table 1). After multivariable adjustment, diabetes was associated with an increased prevalence ratio of awake, sustained, and masked hypertension and a lower prevalence ratio of white coat hypertension compared with individuals without diabetes. In summary, there was an increased prevalence of adverse blood pressure phenotypes among individuals with versus those without diabetes that was not captured in the clinic setting alone. The role of ABPM for identifying high risk individuals with diabetes should be further investigated.
Reproducibility of white coat hypertension and masked hypertension in real-life ambulatory blood pressure monitoring
