Unmasking the Clock: Diurnal Blood Pressure Variation in Patients With Type 2 Diabetes Mellitus With Hypertension via Ambulatory Blood Pressure Monitoring (ABPM)

Introduction Hypertension and type 2 diabetes mellitus (T2DM) frequently coexist, significantly increasing cardiovascular risk. The diurnal variation in blood pressure (BP) is well-established, with BP typically dipping during sleep. However, in T2DM patients with hypertension, this rhythm is often disrupted. This study aims to assess diurnal BP variations in such patients using ambulatory blood pressure monitoring (ABPM). Methods This descriptive cross-sectional study included 100 T2DM patients with hypertension from the Department of Medicine at Lady Hardinge Medical College, New Delhi. ABPM was performed on all participants, recording BP every 30 minutes during the day and every 60 minutes at night. Patients were categorized into normal dippers, nondippers, and reverse dippers based on their nocturnal BP patterns. Statistical analyses, including Chi-square tests and Wilcoxon-Mann-Whitney U tests, were used to determine associations between diurnal rhythm loss and clinical parameters. Results The study found that 88% of participants exhibited a loss of diurnal BP rhythm, with 57% categorized as nondippers and 31% as reverse dippers. Only 12% of patients maintained a normal dipping BP pattern. The findings suggest a higher prevalence of diurnal rhythm loss among female patients (93%) compared to males (75%) (p = 0.034). There was no significant association between BP control and diurnal rhythm loss (p = 0.527), but patients taking antihypertensive medication both in the morning and evening had a significantly lower incidence of diurnal rhythm loss compared to those taking medication only in the morning (p < 0.001). Conclusion This study highlights that the majority of T2DM patients with hypertension exhibit abnormal BP patterns, which may predispose them to an increased risk of cardiovascular complications. Ambulatory BP monitoring is essential for detecting these patterns and optimizing treatment strategies. The findings emphasize the importance of individualized antihypertensive therapy, particularly with a focus on medication timing, to improve diurnal BP rhythm. Future studies should explore larger sample sizes and long-term follow-ups to further validate these findings and assess the impact of chronotherapy on clinical outcomes.