Prognostic significance of the white coat hypertension in patients with type 1 diabetes mellitus

Despite the high prevalence of white coat hypertension (WCH) in diabetes mellitus and the evidence that hypertension is a clear risk factor for the development of microalbuminuria (MA) in these patients, there is no information on the long-term prognostic significance of this condition in the diabetic population. We studied the evolution of 40 patients with type 1 diabetes mellitus (Type 1 DM). Twenty patients with WCH (office blood pressure> or =140/90mmHg associated with mean daytime blood pressure<135/85mmHg) classified as the WCH group and 20 patients with type 1 DM with a similar age and disease evolution, but who were normotensive, (office blood pressure<140/90mmHg associated with mean daytime blood pressure<135/85mmHg) classified as the normotensive control group. After 5 years of follow-up, MA appeared in four subjects and sustained hypertension in another, with a total of 31% of events in the WCH group, with none in the normotensive group. Kaplan-Meier analysis showed that the relative risk of developing these hypertensive events was 25% higher in the WCH group. At baseline, the night time systolic and diastolic blood pressure levels were significantly higher in patients who further developed MA and sustained hypertension. The findings in this study highlight the clinical importance of careful follow-up of type 1 diabetic patients with WCH.