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194 CIRCADIAN PATTERN OF BLOOD PRESSURE, DIABETES MELLITUS AND TARGET ORGAN DAMAGE

Objective: Nephropathy and cardiopathy are the most frequent complications in diabetic hypertensive subjects. The objective is to analyse the features in a cohort of hypertensive subjects in relation with the presence of diabetes and/or target organ damage (TOD) in order to stratify accurately their cardiovascular risk. Methods: 405 hypertensive subjects assessed and stratified basing on their cardiovascular risk were studied. Ambulatory blood pressure monitoring (ABPM), echocardiographic study and lab tests to determine the presence of nephropathy (microalbuminuria –MAL, hidden kidney disease –HKD- or both) were performed. Results: No differences in age, gender, body mass index and previous treatment were seen between both groups, with a longer presence of hypertension in diabetic patients, p<0.0001. When ABPM is analysed, diabetic subjects have higher nocturnal SBP and DBP (p=0.02 and 0.03, respectively) with a significant decrease in the diurnal/nocturnal ratio of SBP (6.2% in diabetics vs 12.1% in non-diabetics,p<0.0001). The most prevalent circadian pattern in diabetics is non-dipper (37.3% vs 27.6%,p<0.0001) and riser (26.2% vs 7.7%,p<0.0001). When TOD is assessed, diabetic subjects have high prevalence of left ventricular hypertrophy (85% vs 34.9%, p<0.0001) and nephropathy, including MAL (25.3% vs 17.1%, p<0.0001) and HKD (36.4% vs 10.4%, p<0.0001). Conclusions: Diabetes and hypertension associated determine a significant alteration in the circadian pattern of BP and higher presence of TOD, especially heart and kidney. The presence of cardiopathy and nephropathy in hypertensives increases the development of cardiovascular complications and the cardiovascular risk in these patients.