The main finding of this study is that the serum ADMA levels were significantly increased in MHT patients with DM compared to normotensive diabetic subjects. ADMA levels, BMI, and low HDL levels were independent predictors of MHT in patients with DM.
ADMA levels positively correlated with ABPM measurements, especially daytime measurements, but were not related to office BP measurements. ADMA levels may play a role in prediction, with a good sensitivity and negative predictive value but poor specificity and positive predictive value. To the best of our knowledge, this is the first study to examine the relationship between ADMA and
MHT in the current literature.
Ng et al. studied in a total of 133 DM patients, 18% of whom had
MHT. It was reported that MHT is associated with a higher prevalence of albuminuria, left ventricular diastolic dysfunction, and hypertrophy compared with normotensive DM [11]. Also, the prevalence of target organ damage was comparable in the MHT group with sustained hypertension in this study. Eguchi et al. reported
MHT prevalence of 46.7% among 81 clinically normotensive
Japanese diabetic persons. In this study, MHT was related to significantly increased incidence of silent brain infarcts and albuminuria
[12]. In another cross-sectional study enrolling a total 135 normotensive patients with type 2 diabetes, the prevalence of MHT was reported as 30% [10]. Based on the current literature, MHT prevalence was higher in type 2 DM subjects and is correlated with target organ damage relative to normotensive diabetics. Therefore, these subjects may have an increased risk of cardiovascular events.
However, the value of cardiovascular risk markers to determine
MHT has not been well studied.
ADMA has been shown to inhib...
... middle of paper ...
...levated ADMA levels are associated with endothelial dysfunction in patients with DM
[25]. Based on these studies, we speculated that ADMA may play a pivotal role in the development of MHT via endothelial dysfunction.
The most important limitation of the present study is that endothelial functions were not measured due a limited budget. Previous work has demonstrated that ADMA causes endothelial dysfunction via suppression of endothelial progenitor cells (EPCs) [26]. EPCs are circulating immature cells that contribute to vascular homeostasis
Fig. 1. Receiver operating curve of ADMA levels to predict of MHT.
4 A. Taner et al. / Atherosclerosis xxx (2013) 1e6
Please cite this article in press as: Taner A, et al., The value of serum asymmetric dimethylarginine levels for the determination of masked hypertension in patients with diabetes mellitus, Atherosclerosis (2013),