Should 24-h Ambulatory Blood Pressure Monitoring Be Done in Every Patient With Diabetes?

Abstract

Twenty-four–hour ambulatory blood pressure monitoring (ABPM) is a method widely used in hypertension diagnosis and management. Also in diabetic subjects, it may be a powerful tool for a better stratification of cardiovascular risk related to elevated blood pressure (BP), one of the most important causes of morbidity and mortality in this population. This is due to its capacity, as compared with isolated office measurements, to more precisely diagnose and quantify a high BP condition in daily life and to detect alterations of 24-h BP profiles such as absence of nocturnal BP fall, postprandial hypotension, or an increased BP variability, which may reflect a deranged cardiovascular regulation often associated with a reduced heart rate variability. It is also an important tool to obtain an accurate assessment of the efficacy of antihypertensive treatment over day and night. Admittedly, this method has its disadvantages, which include relatively high cost, problems with validation of the devices (particularly relevant in special populations such as diabetic patients), and undefined diagnostic threshold in high-risk populations. A number of studies have shown that ABPM may be a useful tool in improving outcome and quality of life in diabetes, suggesting that it should be an integral part of the clinical management in this setting. However, due to its limited availability in clinical practice, it may not be easily applied in every diabetic subject and thus priority should be given to those of diabetic patients, who may derive the most evident benefits from the use of this diagnostic tool. The 24-h ABPM is a method widely used in hypertension diagnosis and management (1–3). Numerous studies over the years have confirmed its advantages over the traditional clinic measurement, including a higher reproducibility, lack of placebo and white coat effect, and, most importantly, its superiority in predicting adverse consequences of …