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Journal of Hypertension:
doi: 10.1097/HJH.0b013e32832be5f9
Original papers: Metabolic aspects

Increased long-term risk of new-onset diabetes mellitus in white-coat and masked hypertension

Mancia, Giuseppea,b; Bombelli, Michelea; Facchetti, Ritaa,c; Madotto, Fabianaa,c; Quarti-Trevano, Foscaa; Grassi, Guidoa,b; Sega, Robertoa

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Abstract

Objective: A sustained blood pressure elevation is associated with an increased risk of new-onset diabetes mellitus. Whether this is the case also in white-coat and masked hypertension is unknown.

Methods: In 1412 individuals of the Pressioni Arteriose Monitorate E Loro Associazioni study stratified for sex and age decades, we measured office, home and 24-h ambulatory blood pressure together with fasting plasma glucose and other metabolic variables. This allowed to identify patients with white-coat, masked, sustained hypertension and true normotension.

Results: Over a 10-year period, the increase in plasma glucose and the incidence of new-onset diabetes (plasma glucose ≥126 mg/dl or use of antidiabetic drugs) was significantly greater in individuals with white-coat and masked hypertension than in those with ‘true’ normotension (age and sex-adjusted risk 2.9 and 2.7, respectively), the increase being similar to that of sustained hypertensive individuals. The adjusted risk showed a marked increase when development of an impaired fasting glucose condition was also considered, and the results were similar when individuals reporting antihypertensive drug treatment were excluded or white-coat and masked hypertension were identified by office versus home blood pressure. The increased risk of new-onset diabetes become no more significant when data were adjusted for initial blood glucose and BMI, which, at a multivariate analysis, were the most significant predictors of this condition, with only a small although significant contribution of the initial blood pressure.

Conclusion: Thus, white-coat and masked hypertension are associated with a long-term greater progression of blood glucose abnormalities and an increased risk of developing diabetes. This is largely accounted for by the metabolic abnormalities that are frequent components of these conditions.

© 2009 Lippincott Williams & Wilkins, Inc.

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