Blood Pressure Phenotypes in Patients Recently Diagnosed With Type 2 Diabetes Mellitus and Matched Controls: A Study...

Accurate characterization of blood pressure (BP) phenotypes is essential for cardiovascular risk assessment, particularly among type 2 diabetes mellitus (T2DM) patients. We aimed to evaluate the prevalence of different BP phenotypes using multiple BP assessment methods, in Black Africans, with and without T2DM. Recently diagnosed T2DM patients (n = 151) and age- and sex- matched controls (1:1) without T2DM had their BP assessed using standard office BP measurement (OBPM), unattended automated office BP measurement (u-AOBP), 24 h ambulatory BP monitoring (ABPM), and home BP monitoring (HBPM). Four BP phenotypes were defined, combining OBPM with each of the remaining methods: normotension, white-coat, masked, and sustained hypertension. Using OBPM + ABPM, T2DM patients were less often classified as normotensive (32.5% vs. 48.3%) and more often as having masked hypertension (23.2% vs. 9.9%) than controls (p = 0.004). Both OBPM + HBPM and OBPM + u-AOBP underestimated masked hypertension and overestimated with-coat hypertension. When compared with OBPM + ABPM, concordance in the classification of participants into four phenotypes (κ, 95%CI) was higher for OBPM + HBPM (T2DM: 0.62, 0.52 - 0.71; controls: 0.70, 0.60-0.80) than for OBPM + u-AOBP (T2DM: 0.51, 0.40-0.61; controls: 0.61, 0.50-0.72) and lower among participants with T2DM. Recently diagnosed T2DM patients showed a higher prevalence of masked hypertension than participants without T2DM. When combined with OBPM, HBPM and u-AOBP failed to identify a large proportion of patients with masked hypertension and overestimated white-coat hypertensions, highlighting the need to incorporate ABPM into evaluation protocols.