| 이주희¹, 배장환¹ , 박정배² , 박창규² , 윤호중² , 최동주² ,안영근² , 신준한² , 임세중² , 배장호² , 김동운¹ ² |
Introduction;
Home blood pressure (BP) measurement has a better prognostic accuracy than office BP measurement. Recently, scarce data exists for comprehensive analysis of home BP monitoring in patients having diabetes (DM).
Methods;
We evaluated 1087 hypertensive patients on anti-hypertensive medication at least for 6 months. They measured home BPs for 7 days and their baseline characteristics and laboratory data were analyzed. The patients divided two groups that having DM or not and compared.
Results;
One hundred seventy four patients (16.4%) had DM and they had a predominance of male (55.1% vs. 44.9%, p=0.030), elderly (56.5±9.6 vs. 59.2±9.3 yrs, p=0.001) and showed higher body weight (65.8±10.6 vs. 67.7±10.3 Kg, p=0.028), BMI (25.0±2.9 vs. 25.7±3.0 Kg/m2, p=0.007), waist circumference (87.0±8.4 vs. 90.3±7.9, p<0.001) and waist-to-hip ratio (88.7±5.5% vs. 91.5±5.2%, p<0.001). They were more prevalent in dyslipidemia (39.1% vs. 47.2%, p=0.045), renal insufficiency (7.8% vs. 15.7%, p=0.001) and had more target organ damages (0.36±0.56 vs. 0.55±0.62, p<0.001) which include left ventricular hypertrophy (LVH), angina, prior myocardial infarction, prior percutaneous coronary intervention and heart failure in the cardiovascular system, and stroke and transient ischemic attack in cerebrovascular system, and DM nephropathy, renal insufficiency and proteinuria in renal system. DM patients showed more metabolic syndrome and had more metabolic risk factors. Total number of anti-hypertensive medication is more numerous in DM patients (1.93±0.85 vs. 2.25±0.93, p<0.001) and they took more statins and anti-platelet agents. The patients who achieved optimal home BP goal were less in DM (36.8% vs. 45.5%, p=0.029) and only 21.3% of DM patients were reached 130/80 mmHg. They showed more frequent reverse-white coat effect (22.3% vs. 30.3%, p=0.020 in systole and 31.6% vs. 46.1%, p<0.001 in diastole) and showed tendency to masked hypertension. Higher systolic BP in the morning, evening, average BP were noted in DM patients.
Conclusion;
Hypertensive patients with DM had worse clinical variables such as obesity, dyslipidemia and target organ damage. They also showed higher home BP profiles, took more anti-hypertensive medications and had higher prevalence of masked hypertension. So, we can suggest that home BP monitoring is very helpful for treatment of hypertension in patients with DM and DM patients should be treated more vigorously.
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