Predictors of the pressor response to the clinic visit in essential hypertensives with and without diabetes mellitus

Abstract

Predictive models for the pressor response to the outpatient clinic visit (PRC) in essential hypertensives with and without diabetes are proposed. The hypotheses are derived from previous studies about the univariate correlates of this response. PRC was measured with ambulatory monitors. Twenty-four hour blood pressures and average PRCs were similar in the two groups. Diabetics had faster 24-h heart rates, decreased heart rate variability, a broader range of PRCs and more depressor responders. PRC of nondiabetics correlated with duration of hypertension and was dependent on race; the predictive model had R2 of 0.19. In contrast, PRC of diabetics exhibited correlations with age, weight, BP and blood glucose and the model had R2 of 0.71. The data suggest that: diabetics had autonomic dysfunction, that their PRC can be modelled with predictors that are accepted correlates of autonomic neuropathy, and that these predictors attenuated PRC or its buffering. If these results were confirmed by prospective application of the model to a larger group of patients, 'true' blood pressures could be estimated by subtraction of predicted PRC from office blood pressures in diabetic, but not in nondiabetic, hypertensive patients.