Ambulatory BP best for assessing diabetes CV risk

Nov 5 2013

By Sara Freeman, medwireNews Reporter

Ambulatory blood pressure monitoring (ABPM) should be used to monitor patients with Type 2 diabetes who have a high risk for developing cardiovascular (CV) complications, say researchers.

“ABPM provides more valuable information regarding cardiovascular risk stratification than office BPs and should be performed, if possible, in every high-risk type 2 diabetic patient,” Gil Salles (University Hospital Clementino Fraga Filho, Rio de Janeiro, Brazil) and colleagues write in the Journal of Hypertension.

Salles et al report the first findings of the prospective Rio de Janeiro Type 2 Diabetes Cohort Study involving 565 individuals with Type 2 diabetes at high risk for CV disease who were assessed using both ABPM and conventional digital BP monitoring over a median of 5.75 years.

Patients were followed up at least three to four times a year, with clinic BP assessed at least four times and ABPM at least twice overall. BP readings were linked to a composite endpoint of fatal and nonfatal cardiovascular events and all-cause mortality.

A total of 88 (15.6%) patients experienced a CV event, including 38 who died of CV-related causes. There were 70 deaths due to any cause, representing 12.4% of patients.

“After adjustments for cardiovascular risk factors, clinic SBP [systolic blood pressure] and DBPs [diastolic blood pressures] were predictive of the composite endpoint but not of all-cause mortality,” the researchers observe. They add, however, that “all ambulatory BP components were predictors of both endpoints.”

The team found that ABPM predicted CV risk at lower BP levels than clinic-derived measurements, with values of ≥120/75 mmHg over a 24-hour period and ≥140/90 mmHg, respectively, signalling an increased CV risk. Furthermore, while additional ABPM readings improved CV risk stratification over the course of follow-up, further clinic BP monitoring did not improve the risk prediction.

Salles et al note that the majority (86.3%) of recruited patients had arterial hypertension at baseline and most were already taking antihypertensive treatment at the time of entry into the study. Achieving an ABPM value of <120/75 mmHg might thus be regarded as more of a therapeutic goal than a diagnostic threshold if confirmed by future studies. Antihypertensive treatment may have also attenuated the results and made the relative risk estimate more conservative, they suggest.

“The Rio de Janeiro Type 2 Diabetes Cohort Study supports the use of ABPM in every high-risk type 2 diabetic individual to improve cardiovascular risk stratification and to target BP goals during antihypertensive treatment, over and beyond clinic BPs,” Salles et al conclude.

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