Impact of White-Coat Hypertension on Microvascular Complications in Type 2 Diabetes

OBJECTIVE — The purpose of this study was to determine the impact of white-coat hypertension (WCH) on microvascular complications in type 2 diabetes. RESEARCH DESIGN AND METHODS — A cross-sectional study was conducted in normotensive patients and patients with WCH selected from a cohort of 319 type 2 diabetic patients. Normotension was defined by office blood pressure �140/90 mmHg and daytime blood pressure �135/85 mmHg on ambulatory blood pressure monitoring (ABPM). WCH was defined as office blood pressure �140/90 mmHg and daytime blood pressure �135/85 mmHg on ABPM. Subjects were evaluated for diabetic nephropathy (24-h urinary albumin excretion rate) and diabetic retinopathy (classified according to the Global Diabetic Retinopathy Group). RESULTS — Forty-six type 2 diabetic patients had WCH (14.4%; mean age 56.6 years; 45.3% men) and 117 had normotension (36.6%; mean age 55.8 years; 37.5 % men). These groups did not differ in clinical and main laboratory characteristics. Systolic ABPM (24-h: 124.7 � 6.7 vs. 121.0 � 8.5 mmHg, P � 0.01 and daytime: 126.6 � 7.2 vs. 123.2 � 8.2 mmHg, P � 0.01) and blood pressure loads were higher in subjects with WCH than in the normotensive subjects. WCH was associated with an increased risk for macroalbuminuria (odds ratio 4.9 [95 % CI 1.3–18.7],