# Hypertensive Diabetic Patients: Casual Pulse Pressure and Ambulatory Blood Pressure Monitoring (ABPM) as Superior Predictors of Future Cardiovascular Events

## TL;DR

This study shows that ambulatory blood pressure monitoring better predicts cardiovascular risks in diabetic patients compared to standard methods.

## Contribution

The study introduces ABPM as a superior predictor for cardiovascular events in hypertensive diabetic patients.

## Key findings

- Diabetic patients had more severe cardiovascular events, heart failure, and higher mortality rates.
- Elevated pulse pressure values in ABPM were linked to worse survival outcomes in diabetic patients.
- Resistant hypertension was more common in diabetic patients and associated with poorer survival.

## Abstract

Hypertensive (HTN) patients with type 2 diabetes mellitus (T2DM) are at an increased risk of adverse survival outcomes compared to non-diabetic individuals. This study aimed to retrospectively evaluate the prognostic significance of ambulatory blood pressure monitoring (ABPM) in a subgroup of diabetic patients. A total of 823 HTN patients, followed since 1994 at a hospital (follow-up: 11.8 ± 5.6 years), were included in the study. These patients underwent ABPM using a SpaceLabs 90207 device (SpaceLabs Healthcare, Snoqualmie, WA, USA) during a normal working day. Data from both the ABPM and office blood pressure (BP) values, as well as cardiovascular risk factors, were analysed. The patients were divided into two groups: diabetic (n = 240) and non-diabetic (n = 583). Data were analysed using IBM SPSS Statistics for Windows, Version 25 (Released 2017; IBM Corp., Armonk, NY, USA). Our study showed that HTN patients with T2DM experienced more severe cardiovascular events (χ² = 25.34, p < 0.001), heart failure (χ² = 27.7, p < 0.001), and mortality (χ² = 11.8, p < 0.01). Also, they had elevated pulse pressure (PP) values (analysed either as a continuous variable or using a 60-mmHg cut-off within ABPM values), which were associated with worse survival outcomes. In the analysis of HTN phenotypes, the presence of resistant hypertension (RH) was significantly higher in the diabetic group (χ² = 8.14, p < 0.05), which is associated with poorer survival. Despite the growing body of research, there are currently no studies in the literature using ABPM data specifically in diabetic patients. These data could offer valuable insights into the BP patterns of these patients, helping to define the most effective therapeutic strategies.