Diabetes Mellitus and 24-Hour Ambulatory Blood Pressure Monitoring

Abstract

Given the increase in prevalence of obesity, survival to older age, and urbanization, the projected global number of people with diabetes mellitus will double within decades (http://www.eatlas.idf.org/Prevalence). Physicians care for an ever-increasing load of elderly patients with diabetes mellitus. As a matter of fact, quality of care of patients with diabetes mellitus has become a measure of quality in internal medicine, and diabetes mellitus practice improvement modules are part of the American Board of Internal Medicine recertification program (http://www.abms.org/Maintenance\_of\_Certification). Recently it became clear that a major (and most reachable) intersection on the road to improving prognosis of patients with diabetes mellitus is the successful lowering of their blood pressure to levels well below those previously considered the goal for subjects without diabetes mellitus. The vast body of research regarding blood pressure of patients with (as well as without) diabetes mellitus relies on office blood pressure measurements. However, it is now clear that 24-hour ambulatory blood pressure (ABP) monitoring provides data that are more closely linked to patients’ daily behavior.1 Compared with office blood pressure, the 24-hour ABP average may be closer to the individual’s “true” blood pressure. This is the basis for the overall stronger links of the latter with target organ damage, cardiovascular events, and, ultimately, survival. Can we apply the vast knowledge generated from hypertensive and general populations with 24-hour ABP monitoring to patients with diabetes mellitus? Are …