BENEFIT OF AMBULATORY BLOOD PRESSURE MEASUREMENT AFTER A MAJOR CARDIOVASCULAR EVENT IN HYPERTENSIVE TYPE 2 DIABETIC

Objective: To compare ambulatory blood pressure measurement (ABPM) values after a major cardiovascular event versus those who had no recurrence, and to assess whether ABPM may have a role in predicting the occurrence of a second major cardiovascular event in type 2 diabetic hypertensive. Design and method: We included 895 hypertensive type 2 diabetic patients who had undergone ABPM after a first major cardiovascular event (acute coronary syndrome, stroke, renal failure), mean age 61.9 ± 12.5 years, 58.2% men, followed for a mean of 2.6 ± 0.9 years. 256 patients developed a second event during the follow-up period. We compared ABPM values between patients who developed a second cardiovascular event and those who did not recur. Results: 24-hour systolic blood pressure (SBP) values were 142 ± 12 mmHg for patients with a major event versus 128 ± 16 mmHg in patients without an event (p = 0.001). SBP values during the waking period were 151 ± 13 mmHg versus 132 ± 11 mmHg respectively (p = 0.003). SBP values during the nocturnal period were 131 ± 11 mmHg versus 110 ± 13 mmHg respectively (p = 0.004). Daytime and nocturnal 24-hour SBP values were significantly associated with the occurrence of a second event, using a Cox model with adjustment for age and gender, with HRs of 1.022 (95% CI: 1.007 - 1.090); 1.032 (95% CI: 1.005 - 1.087) and 1.043 (95% CI: 1.009 - 1.095) respectively. A 24-hour SBP threshold value of 136 mmHg predicted the occurrence of a second major cardiovascular event with a sensitivity of 92%. Conclusions: In hypertensive type 2 diabetic patients with a history of a major cardiovascular event, elevated 24-hour diurnal and nocturnal SBP values are associated with the occurrence of a second major cardiovascular event, necessitating early stabilization of BP figures to avoid these morbid complications.