Background: The prevalence of white-coat hypertension (WCH) and masked hypertension (MH) has not been fully described in diabetic patients. There is still doubt concerning the association between blood pressure (BP) profiles with left ventricular hypertrophy (LVH) variables and diastolic dysfunction. Aims: To evaluate the prevalence of WCH and MH in diabetic hypertensive patients and their association with echocardiographic variables and microalbuminuria. Methods: This was a cross-sectional study with 302 hypertensive diabetic patients. Subjects were submitted to a clinical evaluation, 24h-ambulatory blood pressure monitoring (ABPM) and echocardiography and then classified into controlled hypertension (CH, normal office BP, and ABPM), WCH (high office BP and normal ABPM), MH (normal office BP and high ABPM), and sustained hypertension (SH, high office BP and high ABPM). Multiple linear regression models were used to evaluate the association between blood pressure (BP) profiles with echocardiographic variables and microalbuminuria. Results: Mean age was 57.2 ± 6.1 years, 109 were men. The median HbA1c and diabetes duration was 7.9% (6.8-9.2), and 10 years (5-16), respectively. Prevalences of CH, WCH, MH and SH were 28.8%, 19.9%, 17.5%, and 33.8%, respectively. The SH group had a higher relative wall thickness (P=0.026) and posterior wall thickness (P=0.004). Other variables of LVH and diastolic function were not different among groups. Conclusions: Prevalences of WCH and MH were lower than those estimated in diabetic only patients. We did not find a “dose-response” association between the hypertensive phenotypes and echocardiographic variables of cardiovascular risk. The use of ABPM beyond the classic cardiovascular risk stratification tools must be questioned in high-risk patients.

Background: The prevalence of white-coat hypertension (WCH) and masked hypertension (MH) has not been fully described in diabetic patients. There is still doubt concerning the association between blood pressure (BP) profiles with left ventricular hypertrophy (LVH) variables and diastolic dysfunction. Aims: To evaluate the prevalence of WCH and MH in diabetic hypertensive patients and their association with echocardiographic variables and microalbuminuria. Methods: This was a cross-sectional study with 302 hypertensive diabetic patients. Subjects were submitted to a clinical evaluation, 24h-ambulatory blood pressure monitoring (ABPM) and echocardiography and then classified into controlled hypertension (CH, normal office BP, and ABPM), WCH (high office BP and normal ABPM), MH (normal office BP and high ABPM), and sustained hypertension (SH, high office BP and high ABPM). Multiple linear regression models were used to evaluate the association between blood pressure (BP) profiles with echocardiographic variables and microalbuminuria. Results: Mean age was 57.2 ± 6.1 years, 109 were men. The median HbA1c and diabetes duration was 7.9% (6.8-9.2), and 10 years (5-16), respectively. Prevalences of CH, WCH, MH and SH were 28.8%, 19.9%, 17.5%, and 33.8%, respectively. The SH group had a higher relative wall thickness (P=0.026) and posterior wall thickness (P=0.004). Other variables of LVH and diastolic function were not different among groups. Conclusions: Prevalences of WCH and MH were lower than those estimated in diabetic only patients. We did not find a “dose-response” association between the hypertensive phenotypes and echocardiographic variables of cardiovascular risk. The use of ABPM beyond the classic cardiovascular risk stratification tools must be questioned in high-risk patients.

Background: The prevalence of white-coat hypertension (WCH) and masked hypertension (MH) has not been fully described in diabetic patients. There is still doubt concerning the association between blood pressure (BP) profiles with left ventricular hypertrophy (LVH) variables and diastolic dysfunction. Aims: To evaluate the prevalence of WCH and MH in diabetic hypertensive patients and their association with echocardiographic variables and microalbuminuria. Methods: This was a cross-sectional study with 302 hypertensive diabetic patients. Subjects were submitted to a clinical evaluation, 24h-ambulatory blood pressure monitoring (ABPM) and echocardiography and then classified into controlled hypertension (CH, normal office BP, and ABPM), WCH (high office BP and normal ABPM), MH (normal office BP and high ABPM), and sustained hypertension (SH, high office BP and high ABPM). Multiple linear regression models were used to evaluate the association between blood pressure (BP) profiles with echocardiographic variables and microalbuminuria. Results: Mean age was 57.2 ± 6.1 years, 109 were men. The median HbA1c and diabetes duration was 7.9% (6.8-9.2), and 10 years (5-16), respectively. Prevalences of CH, WCH, MH and SH were 28.8%, 19.9%, 17.5%, and 33.8%, respectively. The SH group had a higher relative wall thickness (P=0.026) and posterior wall thickness (P=0.004). Other variables of LVH and diastolic function were not different among groups. Conclusions: Prevalences of WCH and MH were lower than those estimated in diabetic only patients. We did not find a “dose-response” association between the hypertensive phenotypes and echocardiographic variables of cardiovascular risk. The use of ABPM beyond the classic cardiovascular risk stratification tools must be questioned in high-risk patients.

As alterações vasculares são complicações clínicas secundárias a elevação da pressão arterial que podem comprometer a capacidade funcional e aumentar o risco de mortalidade. Um instrumento utilizado como marcador de doença arterial obstrutiva periférica que vem merecendo amplo interesse clínico e científico é o Índice Tornozelo-Braquial (ITB). Segundo diretrizes para a prática clínica, valores de ITB <=0,9 ou >=1,3 são considerados patológicos e associados a uma alta incidência de morbimortalidade cardiovascular. Este estudo descritivo e de corte transversal teve por objetivo identificar o risco cardiovascular em hipertensos do avental branco por meio da determinação do ITB com uso de esfigmomanômetros oscilométricos automáticos. Foi desenvolvido em um município localizado ao Nordeste do Estado de São Paulo, no período de agosto de 2010 a junho de 2011. Os participantes foram divididos em normotensos, hipertensos e hipertensos do avental branco, classificados de acordo com o diagnóstico médico e resultado da Monitorização Ambulatorial da Pressão Arterial (MAPA). As variáveis investigadas foram: idade, cor da pele, situação familiar conjugal, naturalidade, índice de escolaridade, profissão, peso, estatura, circunferência abdominal, pressão arterial em braços e tornozelos e ITB. O cálculo do ITB foi realizado pela relação da maior pressão arterial sistólica (PAS) da artéria tibial posterior com a maior pressão sistólica das artérias braquiais. As análises descritivas foram realizadas por meio do pacote estatístico StatisticalPackage for the Social Sciences - SPSS, versão 15.0. Utilizou-se análise de variância (ANOVA) para medidas repetidas e teste Tukey para comparações múltiplas das médias. O grau de relação linear nos escores de PAS e ITB foi verificado mediante a utilização do Coeficiente de Correlação de Pearson. Os resultados foram expressos como médias ± erros padrões das médias (EPM), e as diferenças consideradas estatisticamente significantes para p<0,05. Participaram do estudo 135 indivíduos, sendo 37% normotensos, 37% hipertensos e 26% hipertensos do avental branco. Em todos os grupos, a maioria dos participantes é do sexo feminino, de cor branca, vive com o cônjuge, é natural do estado de São Paulo, exerce atividades domésticas e tem ensino fundamental incompleto. Hipertensos do avental branco apresentam risco intermediário na análise de todas as variáveis clínicas estudadas. Apesar de não ter sido encontrada diferença significante na análise dos valores de ITB na comparação dos grupos, alterações compatíveis com doença arterial obstrutiva periférica e calcificação arterial foram observadas somente nos grupos hipertensão e hipertensão do avental branco. A análise do ITB de menor valor mostrou que 10% dos hipertensos e 5,7% dos hipertensos do avental branco apresentaram ITB<=0,9 e 6% dos hipertensos e 11,4% dos hipertensos do avental branco apresentaram ITB>1,3. Há correlação negativa entre os valores de PAS e ITB nos grupos hipertensão e hipertensão do avental branco. Estes achados remetem à premissa de que a hipertensão do avental branco não deve ser compreendida como uma condição benigna, sendo caracterizada por um quadro clínico que pode evoluir para hipertensão arterial estabelecida. A mensuração do ITB merece importância na abordagem clínica dos pacientes, devendo constituir um instrumento de avaliação do risco cardiovascular valorizado pelos profissionais na rotina dos serviços de saúde. / The vascular changes are secondary clinical complications of high blood pressure which can compromise the functional capacity and increase the risk of mortality. The Ankle-Brachial Index (ABI) is an instrument used as a marker of peripheral occlusive arterial disease which has attracted broad scientific and clinical interest. According to guidelines for clinical practice, ABI values <=0.9 or >=1.3 are considered pathological and associated with a high incidence of cardiovascular morbidity and mortality. This descriptive and cross-sectional study aimed at identifying cardiovascular risk in white coat hypertension by determining the ABI through the use of automatic oscillometric sphygmomanometers. The study was performed in a municipality located in the northeastern of the state of São Paulo, from August 2010 to June 2011. Participants were divided into normotensive, hypertensive, and white coat hypertensive subjects, classified according to the medical diagnosis and outcome of Ambulatory Blood Pressure Monitoring (ABPM). The variables investigated were: age, color of skin, marital family situation, nationality, level of education, occupation, weight, height, waist circumference, ankle-brachial blood pressure and ABI. The calculation of ABI was performed by the ratio between the higher systolic blood pressure (SBP) of the posterior tibial artery and the highest systolic brachial artery. Descriptive analyzes were performed using the Statistical Package for Social Sciences Statistical Package - SPSS, version 15.0. The analysis of variance (ANOVA) was used for repeated measures and Tukey test for multiple comparisons of means. The degree of linear relationship in the scores of SBP and ABI was verified by using the Pearson correlation coefficient. The results were expressed as means ± standard errors of the mean (SEM), and the differences were considered statistically significant at p<0.05. The study included 135 subjects, 37% normotensive, 37% hypertensive and 26% white coat hypertensive subjects. In all groups, most participants are female, white, live with the spouse, from the state of São Paulo, housewives and have incomplete elementary education. White coat hypertensive subjects have intermediate risk in the analysis of all clinical variables studied. Although no significant difference was found in the analysis of ABI values in the comparison of groups, changes consistent with peripheral occlusive arterial disease and arterial calcification was observed only in the groups with hypertensive and white coat hypertensive subjects. The analysis of the lower ABI value showed that 10% of hypertensive subjects and 5.7% of white- coat hypertensive subjects had ABI<=0.9 and 6% of hypertensive subjects and 11.4% of white-coat hypertensive subjects had ABI>1.3 . There is a negative correlation between SBP and ABI in the groups of hypertensive and white coat hypertensive subjects. These findings relate to the premise that white coat hypertension should not be understood as a benign condition, being characterized by a clinical condition that can lead to established hypertension. The measurement of ABI deserves importance in clinical management of patients and should be a tool for assessing cardiovascular risk valued by professionals in the routine of health services.

As alterações vasculares são complicações clínicas secundárias a elevação da pressão arterial que podem comprometer a capacidade funcional e aumentar o risco de mortalidade. Um instrumento utilizado como marcador de doença arterial obstrutiva periférica que vem merecendo amplo interesse clínico e científico é o Índice Tornozelo-Braquial (ITB). Segundo diretrizes para a prática clínica, valores de ITB <=0,9 ou >=1,3 são considerados patológicos e associados a uma alta incidência de morbimortalidade cardiovascular. Este estudo descritivo e de corte transversal teve por objetivo identificar o risco cardiovascular em hipertensos do avental branco por meio da determinação do ITB com uso de esfigmomanômetros oscilométricos automáticos. Foi desenvolvido em um município localizado ao Nordeste do Estado de São Paulo, no período de agosto de 2010 a junho de 2011. Os participantes foram divididos em normotensos, hipertensos e hipertensos do avental branco, classificados de acordo com o diagnóstico médico e resultado da Monitorização Ambulatorial da Pressão Arterial (MAPA). As variáveis investigadas foram: idade, cor da pele, situação familiar conjugal, naturalidade, índice de escolaridade, profissão, peso, estatura, circunferência abdominal, pressão arterial em braços e tornozelos e ITB. O cálculo do ITB foi realizado pela relação da maior pressão arterial sistólica (PAS) da artéria tibial posterior com a maior pressão sistólica das artérias braquiais. As análises descritivas foram realizadas por meio do pacote estatístico StatisticalPackage for the Social Sciences - SPSS, versão 15.0. Utilizou-se análise de variância (ANOVA) para medidas repetidas e teste Tukey para comparações múltiplas das médias. O grau de relação linear nos escores de PAS e ITB foi verificado mediante a utilização do Coeficiente de Correlação de Pearson. Os resultados foram expressos como médias ± erros padrões das médias (EPM), e as diferenças consideradas estatisticamente significantes para p<0,05. Participaram do estudo 135 indivíduos, sendo 37% normotensos, 37% hipertensos e 26% hipertensos do avental branco. Em todos os grupos, a maioria dos participantes é do sexo feminino, de cor branca, vive com o cônjuge, é natural do estado de São Paulo, exerce atividades domésticas e tem ensino fundamental incompleto. Hipertensos do avental branco apresentam risco intermediário na análise de todas as variáveis clínicas estudadas. Apesar de não ter sido encontrada diferença significante na análise dos valores de ITB na comparação dos grupos, alterações compatíveis com doença arterial obstrutiva periférica e calcificação arterial foram observadas somente nos grupos hipertensão e hipertensão do avental branco. A análise do ITB de menor valor mostrou que 10% dos hipertensos e 5,7% dos hipertensos do avental branco apresentaram ITB<=0,9 e 6% dos hipertensos e 11,4% dos hipertensos do avental branco apresentaram ITB>1,3. Há correlação negativa entre os valores de PAS e ITB nos grupos hipertensão e hipertensão do avental branco. Estes achados remetem à premissa de que a hipertensão do avental branco não deve ser compreendida como uma condição benigna, sendo caracterizada por um quadro clínico que pode evoluir para hipertensão arterial estabelecida. A mensuração do ITB merece importância na abordagem clínica dos pacientes, devendo constituir um instrumento de avaliação do risco cardiovascular valorizado pelos profissionais na rotina dos serviços de saúde. / The vascular changes are secondary clinical complications of high blood pressure which can compromise the functional capacity and increase the risk of mortality. The Ankle-Brachial Index (ABI) is an instrument used as a marker of peripheral occlusive arterial disease which has attracted broad scientific and clinical interest. According to guidelines for clinical practice, ABI values <=0.9 or >=1.3 are considered pathological and associated with a high incidence of cardiovascular morbidity and mortality. This descriptive and cross-sectional study aimed at identifying cardiovascular risk in white coat hypertension by determining the ABI through the use of automatic oscillometric sphygmomanometers. The study was performed in a municipality located in the northeastern of the state of São Paulo, from August 2010 to June 2011. Participants were divided into normotensive, hypertensive, and white coat hypertensive subjects, classified according to the medical diagnosis and outcome of Ambulatory Blood Pressure Monitoring (ABPM). The variables investigated were: age, color of skin, marital family situation, nationality, level of education, occupation, weight, height, waist circumference, ankle-brachial blood pressure and ABI. The calculation of ABI was performed by the ratio between the higher systolic blood pressure (SBP) of the posterior tibial artery and the highest systolic brachial artery. Descriptive analyzes were performed using the Statistical Package for Social Sciences Statistical Package - SPSS, version 15.0. The analysis of variance (ANOVA) was used for repeated measures and Tukey test for multiple comparisons of means. The degree of linear relationship in the scores of SBP and ABI was verified by using the Pearson correlation coefficient. The results were expressed as means ± standard errors of the mean (SEM), and the differences were considered statistically significant at p<0.05. The study included 135 subjects, 37% normotensive, 37% hypertensive and 26% white coat hypertensive subjects. In all groups, most participants are female, white, live with the spouse, from the state of São Paulo, housewives and have incomplete elementary education. White coat hypertensive subjects have intermediate risk in the analysis of all clinical variables studied. Although no significant difference was found in the analysis of ABI values in the comparison of groups, changes consistent with peripheral occlusive arterial disease and arterial calcification was observed only in the groups with hypertensive and white coat hypertensive subjects. The analysis of the lower ABI value showed that 10% of hypertensive subjects and 5.7% of white- coat hypertensive subjects had ABI<=0.9 and 6% of hypertensive subjects and 11.4% of white-coat hypertensive subjects had ABI>1.3 . There is a negative correlation between SBP and ABI in the groups of hypertensive and white coat hypertensive subjects. These findings relate to the premise that white coat hypertension should not be understood as a benign condition, being characterized by a clinical condition that can lead to established hypertension. The measurement of ABI deserves importance in clinical management of patients and should be a tool for assessing cardiovascular risk valued by professionals in the routine of health services.