Comparison of the measurement of the blood pressure in consultation versus home monitoring for the evaluation of the blood pressure targets in the diabetics of type 2

Abstract

High blood pressure (hypertension) is a key parameter of microvascular and macrovascular complications in the diabetic patient. Target organ damage correlates better with home blood pressure (BP) monitoring than with the measuring of BP in consultation. The objective of this study is to compare the measurement of the blood pressure in consultation versus home monitoring, to evaluate the achievement of the BP targets in patients with type 2 diabetes. We also looked for masked hypertension secondarily. Prospective study at in consultation including known adult hypertensive diabetics of type 2 patients. The measurement of the BP in consultation after a rest of at least 5 minutes, by a validated electronic device. Three measurements are made and the average of the last two measurements is calculated. The home BP monitoring was performed over 7 days by a validated electronic device given to the patient who must perform 3 measurements in the morning on an empty stomach and 3 measurements in the evening before bedtime at one minute intervals. A minimum of 18 measurements is required with a minimum of 6 measurements in the morning and 6 in the evening. BP target reached if the BP in consultation is less than 140 mmHg systolic and 90 mmHg diastolic, and if the home BP monitoring is less than 135 mmHg systolic and 85 mmHg diastolic. A masked hypertension is defined by a normal BP in consultation, and a high BP in home monitoring. We collected 221 diabetics of type 2 patients, hypertension is known in 115 (52%), including 32 women, mean age 59 years with a mean duration of diabetes of 8 years. Obesity in 37%, dyslipidemia in 51%, coronary artery disease in 10%, stroke in 9%, and peripheral arterial disease in 1%, antihypertensive therapy includes: ARBs n = 20, ACE n = 18, Beta-blockers n = 26, diuretics n = 17 and calcium channel blockers n = 4. Thirty-three % of patients are in monotherapy, 27% in dual therapy, and 13% in triple therapy. The average of the systolic BP in consultation is 137 mmHg, and the average of the systolic BP in home monitoring is 125 mmHg, the average difference between them is 12 mmHg, with a statistically significant difference P = 0.009 ( P < 0.05) found by comparing the measure of systolic BP in consultation versus home monitoring. The mean of the diastolic BP in consultation is 80 mmHg and the diastolic BP in home monitoring is 76 mmHg, the average difference between both is 4 mmHg, with a statistically significant difference P = 0.02 ( P < 0.05) between the measurement of the diastolic BP in consultation versus home monitoring. The systolic BP is controlled in 55% of patients in consultation against 72% in home monitoring with a statistically significant difference P = 0.01 ( P < 0.05), and the diastolic BP is controlled in 76% of patients in consultation and in 88% in home monitoring with a statistically significant difference P = 0.02 ( P < 0.05). We detected a masked hypertension in 4 patients. In our series of diabetics of type 2 patients, the comparison of the measurement of BP in consultation against home monitoring for the assessment of the BP targets, found a better evaluation in the home BP monitoring compared to consultation measurement of BP, with a gain of 17% in systolic BP and 12% in diastolic BP. We detected a masked hypertension in 4% of patients.