Masked hypertension defined by ambulatory blood pressure monitoring is associated with an increased serum glucose level and urinary albumin-creatinine ratio

Abstract

The authors evaluated the relationship of hypertensive target organ damage to masked hypertension assessed by ambulatory blood pressure (BP) and home blood pressure (HBP) monitoring in 129 participants without taking antihypertensive medication. Masked hypertension was defined as office BP < or =140/90 mm Hg and 24-hour ambulatory BP > or =130/80 mm Hg. The masked hypertensive participants defined by 24-hour ambulatory BP (n=13) had a higher serum glucose level (126 vs 96 mg/dL, P=.001) and urinary albumin-creatinine ratio (38.0 vs 7.5 mg/gCr, P<.001) than the normotensive participants (n=74); however, these relationships were not observed when the authors defined groups using HBP (> or =135/85 mm Hg). Masked hypertension by both 24-hour ambulatory BP and HBP had a higher urinary albumin-creatinine ratio than normotension by both 24-hour ambulatory BP and HBP (62.1 vs 7.4 mg/gCr, P=.001), and than masked hypertension by HBP alone (9.3 mg/gCr, P=.009). Masked hypertension defined by 24-hour ambulatory BP is associated with an increased serum glucose level and urinary albumin-creatinine ratio, but these relationships are not observed in masked hypertension defined by HBP.

Figure 1

Serum glucose level in subjects with masked hypertension defined by 24‐hour average blood pressure (ABP). Data are shown as adjusted mean (±1 standard error). P values are based on an analysis of covariance that adjusts for age, gender, body mass index, current smoking, presence of hyperlipidemia, presence of impaired fasting glucose or diabetes, office systolic blood pressure, and office diastolic blood pressure. The Bonferroni procedure was used to test the differences in adjusted means among hypertension groups. Values of P<.05 were considered statistically significant. OBP and ABP values were measured in mm Hg MHT indicates masked hypertension; NT, normotension; OBP, office blood pressure; SHT, sustained hypertension; WCHT, white coat hypertension.

Figure 2

Urinary albumin per creatinine excretion ratio (UAR) in subjects with masked hypertension defined by 24‐hour average blood pressure (ABP). Data are shown as adjusted geometric mean (±1 standard error). P values are based on an analysis of covariance that adjusts for age, gender, body mass index, current smoking, presence of hyperlipidemia, presence of impaired fasting glucose or diabetes, office systolic blood pressure, and office diastolic blood pressure. The Bonferroni procedure was used to test the differences in adjusted geometric means among hypertension groups. Values of P<.05 were considered statistically significant. OBP and ABP values were measured in mm Hg. MHT indicates masked hypertension; NT, normotension; OBP, office blood pressure; SHT, sustained hypertension; WCHT, white coat hypertension.

Figure 3

The relationships between hypertensive groups defined by home blood pressure (HBP) and those defined by 24‐hour average blood pressure (BP). Data are shown as the numbers (percentages) of subjects in the hypertensive groups defined by HBP, or the numbers (percentages) of subjects classified in the hypertensive groups by 24‐hour ambulatory BP. K indicates kappa statistic; MHT, masked hypertension; NT, normotension; SHT, sustained hypertension; WCHT, white coat hypertension.

Figure 4

Urinary albumin per creatinine excretion ratio (UAR) in subjects with normotension (NT) or masked hypertension (MHT) defined by home blood pressure (HBP) and/or 24‐hour average blood pressure (ABP) (includes only those with office blood pressure <140/90 mm Hg). Data are shown as the adjusted geometric means (±1 standard error). P values are based on an analysis of covariance that adjusts for age, gender, body mass index, current smoking, presence of hyperlipidemia, and presence of impaired fasting glucose or diabetes. Intergroup differences in the adjusted geometric means were tested using Bonferroni test. Values of P<.05 were considered statistically significant. HBP and ABP values were measured in mm Hg.