Masked Hypertension in Diabetics with Chronic Renal Failure

Nikhil Raju, (2020) Masked Hypertension in Diabetics with Chronic Renal Failure. Masters thesis, Christian Medical College, Vellore.


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BACKGROUND: Hypertension is a lifestyle disease with enormous social and economic burden all over the world and in India. Though various studies have demonstrated the superiority of ambulatory blood pressure monitoring over conventional office blood pressure monitoring in diagnosis and management of hypertension, translation of this knowledge to clinical practice has been lagging behind. This is of particular value in diabetic patients with renal impairment, as it would help in exposing a masked hypertension which is further contributing to the progress of the disease. Very little research has been done in this regard especially in India. AIM OF THE STUDY: To assess the prevalence of masked hypertension/ masked uncontrolled hypertension in diabetics with chronic kidney disease and to assess the profile of ambulatory blood pressure in diabetics with chronic renal failure. OBJECTIVES: To analyze the ambulatory blood pressure monitoring data in diabetics with renal failure to ascertain: 1. Frequency of masked hypertension and masked uncontrolled hypertension. 2. Descriptive analysis of patterns of 24 hour blood pressure variation. DESIGN: Cross-Sectional Observational study. SETTING: All patients presenting to the general medicine out patient departments with a diagnosis of Diabetes with chronic renal failure from July 2019 to July 2019. PATIENTS: 100 consecutive patients presenting to medicine OPD fulfilling the inclusion criteria. METHODOLOGY: Patients who presented to the General Medicine Outpatient department in CMC with a diagnosis of Diabetes Mellitus and evidence of renal impairment were recruited once they satisfied the inclusion criteria and provided consent for the study. Consenting patients were interviewed regarding their medicine intake, history of diabetes, related comorbidities and addictions if any. They underwent a twenty four hours ambulatory blood pressure monitoring on a normal working day.Data from the ambulatory blood pressure machine was analysed along with details of activity and medicine intake provided by the patient in a case report format.Data was entered in Epidata and analyzed with SPSS 17 with the consultation from a statistician. RESULTS: 1. 53.8% of the apparently normotensive diabetics were noted to have masked hypertension. 2. 75.7% of known hypertensives with diabetes and renal impairment who presented to the out patient department with a normal blood pressure had masked uncontrolled hypertension 3. The most prevalent pattern in the overall sample was the non dipping pattern (52%). Non dippers were most common among subjects with masked hypertension (64.3%), true normotension (58.3%) and in masked uncontrolled hypertension (51.18%). The only subgroup that differed was the one with controlled hypertension, where dipping was the most common (61.1%) pattern of ABPM noted. 4. Calcium Channel blocker use is significantly associated with masked uncontrolled hypertension (p=0.04). CONCLUSION: Masked Hypertension and Masked uncontrolled hypertension are two inadequately understood clinical entities with high prevalence in the general population and even higher prevalence in diabetics with renal dysfunction. The normally expected nocturnal dip in Blood pressure is absent in more than half of the diabetics with renal impairment. Further research into this field is necessary to develop more understanding of the masked phenomenon and assess the need for intervention to prevent cardiovascular and renal end organ damage.

Item Type: Thesis (Masters)
Additional Information: 201711461
Uncontrolled Keywords: Masked Hypertension, Masked uncontrolled hypertension, Ambulatory blood pressure monitoring, Diabetes, Renal Failure.
Subjects: MEDICAL > General Medicine
Depositing User: Subramani R
Date Deposited: 28 Jan 2021 19:05
Last Modified: 31 Jan 2021 04:13

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