We assessed whether there is dissociation between ambulatory blood pressure (BP) reduction and clinic BP reduction by antihypertensive medication in hypertensive patients with and without diabetes mellitus (DM).Design and Method:
We formerly performed randomized, multicenter, open-label trial in essential hypertensives. 105 patients with clinic BP ≥ 140/90 mmHg with amlodipine 5 mg were randomly allocated to aliskiren (150–300 mg)/amlodipine (5mg) (ALI/AML) or high-dose amlodipine (10 mg) (h-dAML) group and were treated for 16 weeks. Ambulatory BP and clinic BP were measured at baseline and at the end of the study. In current post-hoc analysis study, we divided 86 patients (age 77.1 years) who completed treatment period into Non-DM (n = 75) or DM (n = 11) group, and compared ambulatory BP reduction and clinic BP reduction. We defined ‘DM’ as antidiabetic treated DM patients or baseline HbA1c ≥ 6.5, and ‘Non-DM’ as the other patients. No type 1 DM patient is included in this study.Results:
There was no significant difference in clinic BP and ambulatory BP at baseline. The reduction of clinic SBP were similar between the Non-DM and DM group (−10.7 ± 18.7 vs. −5.8 ± 18.0 mmHg, p = 0.42), whereas the reduction of 24-h SBP (−7.7 ± 10.9 vs. 1.7 ± 11.5 mmHg, p = 0.01) and daytime SBP (−7.8 ± 13.4 vs. 3.6 ± 13.8 mmHg, p = 0.01) were significantly smaller in the DM group than in the Non-DM group. 24-h SBP and daytime SBP were significantly decreased by treatment only in the Non-DM group.Conclusions:
Although the magnitude of clinic SBP reduction were similar, 24-h SBP reduction and daytime SBP reduction were significantly smaller in DM compared with in Non-DM. Our data suggest that ambulatory BP reduction by antihypertensive medication is insufficient in hypertensive patients with DM.