Blood Pressure Variability in Patients with Hypertension and Type 2 Diabetes Mellitus: Is There More to Do?

Fractal dimension (FD) analysis of ambulatory blood pressure monitoring (ABPM) may provide more information than conventional blood pressure variability (BPV) parameters. This study aims to assess the FDs of ABPM temporal series as a measure of BPV and its impact on optimized blood pressure (BP) control in patients(pts) with hypertension (HT) and type 2 diabetes mellitus (DM). Systolic (SBP) and diastolic (DBP) BP, dipping status, coefficient of variation (CV), and pulse pressure (PP) were analyzed on 24h-ABPM in pts with DM and HT. FDs were determined separately during daytime and nighttime for SBP, DBP, and pulse pressure (PP). 117 pts, 62.8±10.3 yo, 46% male, were divided into G1 (uncontrolled HT, 60 pts) and G2 (controlled HT, 57 pts). 61% were non- dippers or reverse-dippers, mean dipping % was 4.9 ± 8.7 in G1 and 9.6 ± 7.4 in G2 (p=0.002). 46 pts in G1 and 39 had CV > 10% (p=0.31). The mean diurnal SBP FDs were 1.229 ± 0.03 in G1 and 1.2431 ± 0.03 in G2 (p=0.02), associated with DM complications (p=0.005) and HT treatment (p<0.04). In conclusion, fractal analysis revealed a more complex, convoluted BP curve in diabetics with controlled HT, adding complementary data to conventional BPV parameters.