Manuel Idrogo

Characterizing blood pressure control in individuals with Type 2 diabetes: the relationship between clinic and self-monitored blood pressure.

AIMS To determine the relationship between blood pressure (BP) measurement in the clinic and self-monitored blood pressure (SMBP); and to evaluate the accuracy of self-reported data in patients with Type 2 diabetes treated intensively for hypertension. METHODS Seventy subjects had baseline and 1-week follow-up clinic BP measured using an Omron 907 automated device. During a contemporaneous 14-day period these subjects measured their BP at least four times each day using an Omron IC semiautomatic portable monitor which, unknown to them, contained an onboard memory capable of storing BP with corresponding time and date. RESULTS There was no significant difference between mean clinic and mean self-monitored BP. Correlations between clinic BP and SMBP were r=0.61 (P<0.0001) for systolic BP and r=0.69 (P<0.0001) for diastolic BP. Clinic BP classified 56 subjects as uncontrolled hypertension (BP > or = 130/80 mmHg, adjusted for diabetes) and 14 subjects as controlled hypertension. Using World Health Organization-International Society of Hypertension criteria for SMBP (> or = 125/75 mmHg), 55 cases of clinic classified uncontrolled hypertension were confirmed, resulting in 98% sensitivity. Clinic and SMBP agreed in one case of controlled hypertension, resulting in 7% specificity. For all subjects, the median percent of values exceeding SMBP criteria for controlled hypertension was systolic 92% and diastolic 70%. Self-reporting precision averaged 89+/-10% (range 45-100%); under-reporting was 25+/-16% (ranging from 0 to 56%) and over-reporting was 12+/-15% (ranging from 0 to 46%). The overall logbook mean was not significantly different from the downloaded data from the Omron IC(R) monitors. CONCLUSIONS SMBP was able to identify 13 patients with uncontrolled hypertension who, by clinic BP measurement, had been classified as controlled.6th Diabetic Neuropathy Satellite Symposium to the 18th International Diabetes Federation Congress in conjunction with the 13th Annual Meeting of the Diabetic Neuropathy Study Group of the EASD (NEURODIAB XIII), Saint Malo, France. Deadline for submission of abstracts: 1st March, 2003. For registration please contact: Agence EVIC, 58, rue Trousseau, 75011 Paris, France Tel : +33-1-4923 0117 Fax : +33-1-4923 8019, E-mail: camillevoisin@evicevents.com, website: www.evicevents.com. For abstract submission please contact: Prof. Andrew Boulton, Chairman, Scientific Committee, Department of Medicine, Orange Zone Corridor, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK. Tel: +44 161 276 4452, Fax: +44 161 274 4740, E-mail: aroscoe@ central.cmht.nwest.nhs.uk. For further information please contact: Prof. Dan Ziegler, Chairman, Organising Committee and NEURODIAB, German Diabetes Research Institute at the Heinrich Heine University, Auf’m Hennekamp 65, D-40225 Düsseldorf, Germany. Tel: +49-211-33821, Fax: +49-211-3382277 or +49-211-3382603, E-mail: dan.ziegler@ddfi.uni-duesseldorf.de, website: www.neurodiab.org

Undetected, uncontrolled blood pressure in type 2 diabetes: self‐monitored blood pressure profiles

Objectives: To construct a novel and clinically relevant means of representing self‐monitored blood pressure (SMBP). Methods: Patients treated to an office blood pressure (BP) <130/80 mmHg measured their BP at home for 14 days using an Omron IC® semi‐automatic portable monitor with memory. SMBP data were transferred from the monitor to a computer to produce graphic profiles (SMBPp) that depict the hourly variation in BP throughout a “typical” or modal day. Results: Office BP and SMBP data from 66 subjects with type 2 diabetes and hypertension (HTN), who completed a previous study of intensified management, were analyzed based on European Society of Hypertension‐European Society of Cardiology (ESH‐ESC) classifications. Patients were classified as Optimal (6), Normal (12), High Normal (15), Isolated systolic HTN (29) and Grades 1, 2 or 3 HTN (4). SMBP disagreed in 32 cases, placing 29 patients in higher risk categories. Analysis by SMBPp of the 33 patients originally classified as Optimal, Normal or High Normal showed that on average 50 ± 31% of their systolic SMBP values exceeded ESH‐ESC thresholds for HTN (135 mmHg). It also revealed that 74 ± 21% of their SMBP values exceeded the treatment goal (<125 mmHg) for high‐risk patients with type 2 diabetes. Conclusions: SMBPp allowed for a definitive measurement of the dynamic daily BP changes. It produced compelling evidence of persistent patterns of BP fluctuations among patients with normal office BP whose uncontrolled HTN would have remained undetected.

Diabetes in the Hispanic population: High risk warrants targeted screening and treatment

PREVIEW As the Hispanic population in the United States increases, more primary care physicians are being challenged to address the high incidence of diabetes and related metabolic disorders in Hispanic American patients. A variety of genetic, environmental, and socioeconomic factors contribute to this groups high susceptibility to diabetes. In this article, Drs Idrogo and Mazze discuss diagnosis of diabetes in Hispanic patients, as well as culturally sensitive screening and treatment strategies.

Characterizing blood pressure control in individuals with Type 2 diabetes: the relationship between clinic and self-monitored blood pressure: Original article

Aims To determine the relationship between blood pressure (BP) measurement in the clinic and self‐monitored blood pressure (SMBP); and to evaluate the accuracy of self‐reported data in patients with Type 2 diabetes treated intensively for hypertension.