Abstract
The association between diabetes mellitus (DM) and masked hypertension (MH) in ambulatory blood pressure (BP) monitoring is established, but its relationship with home BP monitoring (HBPM) remains uncertain. This web-based database study compared BP phenotypes in individuals using (n = 51,194; 6.05% with DM) and not using (n = 55,320; 0.63% with DM) antihypertensive medications (AH) undergoing HBPM. Multivariable logistic regression analysis revealed similar MH and white-coat hypertension (WCH) prevalence in individuals with or without DM, irrespective of AH use. However, among AH non-users, DM was associated with a higher likelihood of normotension (OR 1.35, 95%CI 1.09–1.66; p = 0.006) and a lower likelihood of sustained hypertension (OR 0.77, 95%CI 0.60–0.99; p = 0.039) compared to individuals without DM. These findings suggest that while DM does not significantly impact MH and WCH in HBPM, it may influence normotension and sustained hypertension rates in AH non-users.

Likelihood of diabetes mellitus according to blood pressure phenotypes. AH – antihypertensive medications; CH – controlled hypertension; MH – masked hypertension; MUCH – masked uncontrolled hypertension; NT – normotension; SH – sustained hypertension; SUCH – sustained uncontrolled hypertension; WCH – white-coat hypertension; WUCH – white-coat uncontrolled hypertension.
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References
Nadruz W, Claggett B, Henglin M, Shah AM, Skali H, Rosamond WD, et al. Widening racial differences in risks for coronary heart disease. Circulation. 2018;137:1195–7.
Nadruz W, Claggett B, Henglin M, Shah AM, Skali H, Rosamond WD, et al. Racial disparities in risks of stroke. N. Engl J Med. 2017;376:2089–90.
Jia G, Sowers JR. Hypertension in diabetes: an update of basic mechanisms and clinical disease. Hypertension. 2021;78:1197–205.
Mancia G, Kreutz R, Brunström M, Burnier M, Grassi G, Januszewicz A, et al. 2023 ESH Guidelines for the management of arterial hypertension the Task Force for the management of arterial hypertension of the European Society of Hypertension. J Hypertens 2023;41:1874–2071.
Mancia G, Facchetti R, Vanoli J, Dell’Oro R, Seravalle G, Grassi G. White-coat hypertension without organ damage: impact on long-term mortality, new hypertension, and new organ damage. Hypertension. 2022;79:1057–66.
Palla M, Saber H, Konda S, Briasoulis A. Masked hypertension and cardiovascular outcomes: an updated systematic review and meta-analysis. Integr Blood Press Control. 2018;11:11–24.
Franklin SS, Thijs L, Li Y, Hansen TW, Boggia J, Liu Y, et al. Masked hypertension in diabetes mellitus: treatment implications for clinical practice. Hypertension. 2013;61:964–71.
Marchesi C, Maresca AM, Solbiati F, Franzetti I, Laurita E, Nicolini E, et al. Masked hypertension in type 2 diabetes mellitus. relationship with left-ventricular structure and function. Am J Hypertens. 2007;20:1079–84.
Gorostidi M, De La Sierra A, González-Albarrán O, Segura J, De La Cruz JJ, Vinyoles E, et al. Abnormalities in ambulatory blood pressure monitoring in hypertensive patients with diabetes. Hypertens Res. 2011;34:1185–9.
Andalib A, Akhtari S, Rigal R, Curnew G, Leclerc JM, Vaillancourt M, et al. Determinants of masked hypertension in hypertensive patients treated in a primary care setting. Intern Med J. 2012;42:260–6.
Cacciolati C, Hanon O, Alpérovitch A, Dufouil C, Tzourio C. Masked hypertension in the elderly: cross-sectional analysis of a population-based sample. Am J Hypertens. 2011;24:674–80.
Hosaka M, Mimura A, Asayama K, Ohkubo T, Hayashi K, Kikuya M, et al. Relationship of dysregulation of glucose metabolism with white-coat hypertension: the Ohasama study. Hypertens Res. 2010;33:937–43.
Alves MAM, Feitosa ADM, Mota-Gomes MA, Paiva AMG, Barroso WS, Miranda RD, et al. Accuracy of screening strategies for masked hypertension: a large-scale nationwide study based on home blood pressure monitoring. Hypertens Res. 2023;46:742–50.
Barbosa ECD, Feitosa ADM, Sentalin MVR, Mota-Gomes MA, Barroso WS, Miranda RD, et al. Impact of environmental temperature on blood pressure phenotypes: a nationwide home blood pressure monitoring study. Eur J Prev Cardiol. 2024;31:e35–7.
Vinik AI, Erbas T, Casellini CM. Diabetic cardiac autonomic neuropathy, inflammation and cardiovascular disease. J Diabetes Investig. 2013;4:4–18.
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ADMF, MAM-G, and WSB are consultants for Omron.
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Diniz, P.G.S., Bezerra, R., Feitosa, C.L. et al. Prevalence of masked and white-coat hypertension among individuals with diabetes: insights from web-based home blood pressure monitoring in the Brazilian population. Hypertens Res 47, 3473–3479 (2024). https://doi.org/10.1038/s41440-024-01842-0
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DOI: https://doi.org/10.1038/s41440-024-01842-0