White coat effect and masked uncontrolled hypertension in treated hypertensive-diabetic patients: Prevalence and target organ damage.

BACKGROUND: The association between hypertensive phenotypes of controlled hypertension (CH), white-coat effect (WCE), masked uncontrolled hypertension (MUH) and sustained hypertension (SH) with target organ damage have not been clearly established in diabetic hypertensive treated patients. The present study aims to evaluate the prevalence of the four phenotypes considering the current cut-off points for office and 24 h-ambulatory blood pressure monitoring (ABPM) and the association with left ventricle hypertrophy (LVH), diastolic function and nephropathy. METHODS: Cross-sectional study with 304 patients on anti-hypertensive treatment aged 57.6 ± 6.1 years, who were submitted to ABPM and echocardiography. They were classified into CH (normal office BP and ABPM), WCE (high office BP and normal ABPM), MUH (normal office BP and high ABPM), and SH (high office BP and ABPM). RESULTS: Median HbA1c and diabetes duration were 7.9% (6.8-9.2), and 10 years (5-16), respectively. Prevalences of CH, WCE, MUH and SH were 27.3%, 17.1%, 18.8%, and 36.8%. MUH prevalence was higher than previously described. There was a significant increasing trend across the four groups in variables related to LVH (P < 0.001 for trend). There was not a clear "dose-response" relationship of the four hypertensive phenotypes with nephropathy and diastolic function. CONCLUSION: The use of ABPM beyond the traditional cardiovascular risk stratification tools has limitations, but is still useful in high-risk patients. Longitudinal studies could better evaluate the role of the use of ABPM in this scenario. Cut-off points for normality of office and ABPM influence the prevalences of WCH and MUH.

Precipitating factors of diabetic ketoacidosis at a public hospital in a middle-income country.

AIMS: To study precipitating factors of diabetic ketoacidosis (DKA) at a public hospital in a middle-income country. METHODS: Eighty patients with type 1 diabetes who had an emergency hospitalization for DKA between January 2005 and March 2010 at a tertiary care teaching hospital in Southern Brazil were studied. Data were collected by reviewing medical records and telephone calls. Treatment non-adherence was defined as the precipitating factor if there was diet abuse or insulin therapy noncompliance without identifiable infection. RESULTS: The mean age of patients was 26±13 years. The majority (91.5%) of the patients had unsatisfactory metabolic control before the hospitalization. The most common DKA precipitating factor was treatment non-adherence: 39% of cases when all patients were evaluated and 49% when only patients with previous type 1 diabetes diagnosis were analyzed. Comparison between patients with DKA precipitated by treatment non-adherence and by other causes showed that the former group had more episodes of previous DKA and more frequently reported insulin omission previous to DKA. CONCLUSIONS: Treatment noncompliance is the leading precipitating factor of DKA in Southern Brazil. Further efforts to reduce the occurrence of DKA should focus on patients with prior reports and evidence of treatment non-adherence.