L'hypertension artérielle masquée chez les diabétiques de type 2 : Prévalence, facteurs associés et retentissement cardiovasculaire

Abstract

Problematic and objectiveMasked arterial hypertension (MHTN) is a recently described entity that is associated with the same cardiovascular risk as permanent hypertension. Its prevalence is more frequent in patients with diabetes.The objective of this study is to assess the value of systematic screening for MHTN by 24-hour blood pressure monitoring in a population of type 2 diabetic patients by estimating its prevalence and looking for predictive factors of MHTN in this population. MethodsThrough a prospective study, we recruited normotensive type 2 diabetics for clinical measurement, in whom we systematically searched for MHTN by performing an ambulatory blood pressure measurement (ABPM). The diagnosis of MHTN is established if: mean daytime BP ≥ 135/85 mmHg and / or, mean nighttime BP ≥ 120/70 mmHg and / or, mean 24 hour BP ≥ 130/80 mmHg. We then compared the two populations of MHTN (G1) and normotensive (G2) on clinical and laboratory parameters and we assessed end-organ damage in order to identify the predictive factors of MHTN. ResultsWe recruited 53 patients whose mean age was 55.3 ± 8.4 years (range 35-72 years) with a female predominance (53%). The duration of diabetes was on average 8.7 ± 3.9 years with extremes between 2 and 17 years. The average BMI of our patients was 28.2 ± 5.3 Kg/m2. Overweight was found in almost half of our patients (47.2%). Obesity was found in 32.1% of cases. Metabolic syndrome was found in 64.2% of patients.In our study, the prevalence of HTAM in type 2 diabetics was 64%. We also found that MHTN was more often nocturnal (58.5%) and occurred mainly in non-dipper patients. Left ventricular hypertrophy, microalbuminuria and arterial stiffness evidenced by pulse pressure greater than 60mmHg were more common in the MHTN group.For the predictive factors of MHTN, we were able to collect in univariate analysis the following factors: duration of diabetes, fasting blood sugar, weight and microalbuminuria. In multivariate analysis, the predictive factors that emerged in our study are poor glycemic control (HbA1c ≥7%), high BMI and duration of diabetes. ConclusionMHTN should be sought in diabetics because it allows a better assessment of the cardiovascular risk, in particular by identifying end-organ damage.