Correlation of Isolated Masked Nocturnal Hypertension with Retinopathy in Diabetic Patients

Hemn Muhammed Mustafa; Taha Othman Mahwi; Zagros Ghaffor Rashid

doi:10.54133/ajms.v11i1.3129

Authors

Hemn Muhammed Mustafa Branch of Clinical Sciences, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq https://orcid.org/0000-0002-1345-7961
Taha Othman Mahwi Branch of Clinical Sciences, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq https://orcid.org/0000-0001-9477-8814
Zagros Ghaffor Rashid Branch of Clinical Sciences, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq https://orcid.org/0009-0000-0678-3112

DOI:

https://doi.org/10.54133/ajms.v11i1.3129

Keywords:

Ambulatory blood pressure monitoring, Diabetes mellitus, Masked nocturnal hypertension, Retinopathy

Abstract

Background: The most common cause of visual impairment in the working-age population is diabetic retinopathy. Hypertension is thought to directly or indirectly cause 35% to 75% of diabetes complications. The prevalence of masked hypertension and masked nocturnal hypertension is higher in diabetic patients. In those who have diabetes mellitus, nocturnal blood pressure appears to be more relevant for the development of diabetic retinopathy. Objective: To assess the relationship between isolated masked nocturnal hypertension and retinopathy in diabetic patients. Methods: An observational case-control study was conducted on 234 individuals with diabetes; 117 of them have retinopathy, while the remaining do not. All patients were assessed for hypertension by measuring blood pressure in the office and through 24-hour ambulatory blood pressure monitoring. Results: Twenty-three percent of all assessed patients had masked hypertension. Isolated masked nocturnal hypertension (IMNH) was detected in 15.4% of those with retinopathy, while it was 6% for those without retinopathy. There was a significant relationship between IMNH and the severity of retinopathy. IMNH was more prevalent in those aged 40 years and older, as well as in overweight and obese patients. Conclusions: The current study indicated that diabetic patients with retinopathy exhibited a higher prevalence of masked nocturnal hypertension than those without retinopathy. This result could indicate that masked nocturnal hypertension plays a contributory role in the development of retinopathy.

Downloads

Download data is not yet available.

References

Porta M, Bandello F. Diabetic retinopathy: a clinical update. Diabetologia. 2002;45(12):1617-1634. doi: 10.1007/s00125-002-0990-7

da Costa Rodrigues T, Pecis M, Azevedo MJ, Esteves JF, Gross JL. Ambulatory blood pressure monitoring and progression of retinopathy in normotensive, normoalbuminuric type 1 diabetic patients: a 6-year follow-up study. Diabetes Res Clin Pract. 2006;74(2):135-140. doi: 10.1016/j.diabres.2006.03.016.

Ruta LM, Magliano DJ, Lemesurier R, Taylor HR, Zimmet PZ, Shaw JE. Prevalence of diabetic retinopathy in Type 2 diabetes in developing and developed countries. Diabet Med. 2013;30(4):387-398. doi: 10.1111/dme.12119.

No authors listed. The absence of a glycemic threshold for the development of long-term complications: the perspective of the Diabetes Control and Complications Trial. Diabetes. 1996;45(10):1289-1298. PMID: 8826962.

Klein R, Klein BE, Moss SE, Cruickshanks KJ. The Wisconsin Epidemiologic Study of Diabetic Retinopathy. XV. The long-term incidence of macular edema. Ophthalmology. 1995;102(1):7-16. doi: 10.1016/s0161-6420(95)31052-4.

McFarlane SI, Bakris GL, (Editors), Diabetes and hypertension: evaluation and management, Springer Science & Business Media 2012. Available at: https://link.springer.com/rwe/10.1007/978-3-319-20797-1_31-2

Wijkman M, Länne T, Engvall J, Lindström T, Ostgren CJ, Nystrom FH. Masked nocturnal hypertension--a novel marker of risk in type 2 diabetes. Diabetologia. 2009;52(7):1258-1264. doi: 10.1007/s00125-009-1369-9.

Bromfield SG, Shimbo D, Bertoni AG, Sims M, Carson AP, Muntner P. Ambulatory blood pressure monitoring phenotypes among individuals with and without diabetes taking antihypertensive medication: the Jackson Heart Study. J Hum Hypertens. 2016;30(12):731-736. doi: 10.1038/jhh.2016.27.

de Boer IH, Bangalore S, Benetos A, Davis AM, Michos ED, Muntner P, et al. Diabetes and hypertension: A position statement by the American Diabetes Association. Diabetes Care. 2017;40(9):1273-1284. doi: 10.2337/dci17-0026.

Najafi MT, Khaloo P, Alemi H, Jaafarinia A, Blaha MJ, Mirbolouk M, et al. Ambulatory blood pressure monitoring and diabetes complications: Targeting morning blood pressure surge and nocturnal dipping. Medicine (Baltimore). 2018;97(38):e12185. doi: 10.1097/MD.0000000000012185.

Eguchi K, Ishikawa J, Hoshide S, Pickering TG, Shimada K, Kario K. Masked hypertension in diabetes mellitus: a potential risk. J Clin Hypertens (Greenwich). 2007;9(8):601-607. doi: 10.1111/j.1524-6175.2007.06610.x.

Hodgkinson J, Mant J, Martin U, Guo B, Hobbs FD, Deeks JJ, et al. Relative effectiveness of clinic and home blood pressure monitoring compared with ambulatory blood pressure monitoring in diagnosis of hypertension: systematic review. BMJ. 2011;342:d3621. doi: 10.1136/bmj.d3621.

Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 Practice Guidelines for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. Blood Press. 2018;27(6):314-340. doi: 10.1080/08037051.2018.1527177.

Parati G. Blood pressure variability: its measurement and significance in hypertension. J Hypertens Suppl. 2005;23(1):S19-25. doi: 10.1097/01.hjh.0000165624.79933.d3.

Ohkubo T, Hozawa A, Nagai K, Kikuya M, Tsuji I, Ito S, et al. Prediction of stroke by ambulatory blood pressure monitoring versus screening blood pressure measurements in a general population: the Ohasama study. J Hypertens. 2000;18(7):847-854. doi: 10.1097/00004872-200018070-00005.

Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39(33):3021-3104. doi: 10.1093/eurheartj/ehy339.

Pickering TG, Davidson K, Gerin W, Schwartz JE. Masked hypertension. Hypertension. 2002;40(6):795-796. doi: 10.1161/01.hyp.0000038733.08436.98.

Omboni S, Aristizabal D, De la Sierra A, Dolan E, Head G, Kahan T, et al. Hypertension types defined by clinic and ambulatory blood pressure in 14 143 patients referred to hypertension clinics worldwide. Data from the ARTEMIS study. J Hypertens. 2016;34(11):2187-2198. doi: 10.1097/HJH.0000000000001074.

Li Y, Staessen JA, Lu L, Li LH, Wang GL, Wang JG. Is isolated nocturnal hypertension a novel clinical entity? Findings from a Chinese population study. Hypertension. 2007;50(2):333-339. doi: 10.1161/HYPERTENSIONAHA.107.087767.

Nolde JM, Kiuchi MG, Lugo-Gavidia LM, Ho JK, Chan J, Matthews VB, et al. Nocturnal hypertension: a common phenotype in a tertiary clinical setting associated with increased arterial stiffness and central blood pressure. J Hypertens. 2021;39(2):250-258. doi: 10.1097/HJH.0000000000002620.

Ogedegbe G, Spruill TM, Sarpong DF, Agyemang C, Chaplin W, Pastva A, et al. Correlates of isolated nocturnal hypertension and target organ damage in a population-based cohort of African Americans: the Jackson Heart Study. Am J Hypertens. 2013;26(8):1011-1016. doi: 10.1093/ajh/hpt064.

Kim SH, Shin C, Kim S, Kim JS, Lim SY, Seo HS, et al. Prevalence of isolated nocturnal hypertension and development of arterial stiffness, left ventricular hypertrophy, and silent cerebrovascular lesions: The KoGES (Korean Genome and Epidemiology Study). J Am Heart Assoc. 2022;11(19):e025641. doi: 10.1161/JAHA.122.025641.

Li Y, Wang JG. Isolated nocturnal hypertension: a disease masked in the dark. Hypertension. 2013;61(2):278-283. doi: 10.1161/HYPERTENSIONAHA.111.00217.

Dolan E, Stanton A, Thijs L, Hinedi K, Atkins N, McClory S, et al. Superiority of ambulatory over clinic blood pressure measurement in predicting mortality: the Dublin outcome study. Hypertension. 2005;46(1):156-161. doi: 10.1161/01.HYP.0000170138.56903.7a.

Fagard RH, Thijs L, Staessen JA, Clement DL, De Buyzere ML, De Bacquer DA. Night-day blood pressure ratio and dipping pattern as predictors of death and cardiovascular events in hypertension. J Hum Hypertens. 2009;23(10):645-653. doi: 10.1038/jhh.2009.9.

Birkenhäger AM, van den Meiracker AH. Causes and consequences of a non-dipping blood pressure profile. Neth J Med. 2007;65(4):127-131. PMID: 17452760.

Leitão CB, Canani LH, Kramer CK, Boza JC, Pinotti AF, Gross JL. Masked hypertension, urinary albumin excretion rate, and echocardiographic parameters in putatively normotensive type 2 diabetic patients. Diabetes Care. 2007;30(5):1255-1260. doi: 10.2337/dc06-2131.

Cruickshank K, Riste L, Anderson SG, Wright JS, Dunn G, Gosling RG. Aortic pulse-wave velocity and its relationship to mortality in diabetes and glucose intolerance: an integrated index of vascular function? Circulation. 2002;106(16):2085-2090. doi: 10.1161/01.cir.0000033824.02722.f7.

Gillow JT, Gibson JM, Dodson PM. Hypertension and diabetic retinopathy--what's the story? Br J Ophthalmol. 1999;83(9):1083-1087. doi: 10.1136/bjo.83.9.1083.

Leitão CB, Canani LH, Kramer CK, Moehlecke M, Pinto LC, Ricardo ED, et al. Blood pressure means rather than nocturnal dipping pattern are related to complications in Type 2 diabetic patients. Diabet Med. 2008;25(3):308-13. doi: 10.1111/j.1464-5491.2007.02354.x.

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: Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA). J Hypertens. 2023;41(12):1874-2071. doi: 10.1097/HJH.0000000000003480.

Ghanchi F; Diabetic Retinopathy Guidelines Working Group. The Royal College of Ophthalmologists' clinical guidelines for diabetic retinopathy: a summary. Eye (Lond). 2013;27(2):285-287. doi: 10.1038/eye.2012.287.

Rodrigues TC, Canani LH, Viatroski RS, Hoffmann LH, Esteves JF, Gross JL. Masked hypertension, nocturnal blood pressure and retinopathy in normotensive patients with type 1 diabetes. Diabetes Res Clin Pract. 2010;87(2):240-245. doi: 10.1016/j.diabres.2009.10.016.

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(10):1079-1084. doi: 10.1016/j.amjhyper.2007.06.005.

Klein R, Moss SE, Sinaiko AR, Zinman B, Gardiner R, Suissa S, et al. The relation of ambulatory blood pressure and pulse rate to retinopathy in type 1 diabetes mellitus: the renin-angiotensin system study. Ophthalmology. 2006;113(12):2231-2236. doi: 10.1016/j.ophtha.2006.06.003.

Patel V, Rassam S, Newsom R, Wiek J, Kohner E. Retinal blood flow in diabetic retinopathy. BMJ. 1992;305(6855):678-683. doi: 10.1136/bmj.305.6855.678.

Mateo-Gavira I, Vílchez-López FJ, García-Palacios MV, Carral-San Laureano F, Jiménez-Carmona S, Aguilar-Diosdado M. Nocturnal blood pressure is associated with the progression of microvascular complications and hypertension in patients with type 1 diabetes mellitus. J Diabetes Complications. 2016;30(7):1326-1332. doi: 10.1016/j.jdiacomp.2016.05.021.