Evaluation of 24-Hour Blood Pressure and Arrhythmias through Simultaneous Ambulatory Blood Pressure Monitoring and Holter Monitoring in Type 2 Diabetes Mellitus Patients with Hypertension

Abstract

We studied 1200 (Males=868, Females =332) hypertensive, T2DM hospitalised for 24 hours to analyse the association of hypertension and arrhythmias simultaneously for three years (January 2015-December 2017), as part of the PREDICT protocol, a mixed methods approach, developed as a standard care of management at three tertiary care hospitals. We used Trillium 3000 Holter recorder (Forest Medical) and DynaPulse 5000A Ambulatory Blood Pressure monitoring (ABPM) and the Trillium Gold software, respectively for the recording and the data analysis. ANOVA, Graphpad was used for statistical analysis. The mean age was 51.2 ± 7.9 years (range 41-82 years). The tertile in the triad of age > 60 years, duration of diabetes > 20 years and HbA1c > 11% had the highest incidence of arrhythmias (p<0.0001). The socioeconomic status was high in 401 patients (43%), middle income in 436 (36.3%) and low income in 363 cases (30%). The commonest risk factors were sedentary lifestyle (64%), obesity (56%), dyslipidemia (37%), smoking (23%), sleep apnea (21%). The mean 24-hour BP was 143 ± 12 mmHg for the SBP and 92.6 ± 12.2 mmHg for DBP. The awake and asleep BP mean were respectively 147 ± 11 mmHg and 137 ± 13.7 mmHg for SBP, 89.5 ± 10.2 and 83.1 ± 8.9 mmHg for DBP. Arterial pressure variability and bradyarrhythmia were significantly associated with sleep apnea (p<0.0001). Patients with ST-T wave depression > 1 mm (26%) and tachycardia (31%) as a sub-group were significantly associated with both the reverse dippers and non-dippers. (p<0.0001). Chronotherapy in concurrence with the circadian rhythm to reduce the side effects, optimise the dosage, reduce the pill burden would be a suitable option to achieve a better BP control in T2DM. Nocturnal anti-hypertensive dosing to target the nocturnal hypertension would be an appropriate management approach. Disclosure V. Redkar: None. S. Redkar: None. S. Redkar: None. A. Inamdar: None. M. Inamdar: None. S. Rane: None. D. Khanolkar: None. M. Jagtap: None. D. Yeralkar: None. N. Wadhwa: None.