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    The relationship between exercise capacity and masked hypertension in sedentary patients with diabetes mellitus
    (Taylor & Francis Inc, 2014) Akıllı, Hakan; Kayrak, Mehmet; Arıbaş, Alpay; Tekinalp, Mehmet; Ayhan, Selim Suzi
    Aim: Although exaggerated blood pressure responses (EBPR) to exercise have been related to future hypertension and masked hypertension (MHT), the relationship between exercise capacity and MHT remains unclear. A sedentary life style has been related to increased cardiovascular mortality, diabetes mellitus (DM), and hypertension. In this study, we aimed to examine the relationship between exercise capacity and MHT in sedentary patients with DM. Methods: This study included 85 sedentary and normotensive patients with DM. Each patient's daily physical activity level was assessed according to the INTERHEART study. All patients underwent an exercise treadmill test, and exercise duration and capacity were recorded. Blood pressure (BP) was recorded during all exercise stages and BP values >= 200/110 mmHg were accepted as EBPR. MHT was diagnosed in patients having an office BP < 140/90 mmHg and a daytime ambulatory BP > 135/85 mmHg. Patients were divided into two groups according to their ambulatory BP monitoring (MHT and normotensive group). Results: The prevalence of MHT was 28.2%. Exercise duration and capacity were lower in the MHT group than in the normotensive group (p < 0.05) and were negatively correlated with age, HbA1c, mean daytime BP, and mean 24 hour BP. Peak exercise systolic BP and the frequency of EBPR were both increased in the MHT group (25.0% and 8.1%, respectively, p = 0.03). According to a multivariate regression, exercise capacity (OR: 0.61, CI95%: 0.39-0.95, p = 0.03), EBPR (OR: 9.45, CI95%: 1.72-16.90, p = 0.01), and the duration of DM (OR: 0.84, CI95%: 0.71-0.96, p = 0.03) were predictors of MHT. Conclusion: Exercise capacity, EBPR, and the duration of DM were predictors of MHT in sedentary subjects with DM.
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    The value of serum asymmetric dimethylarginine levels for the determination of masked hypertension in patients with diabetes mellitus
    (Elsevier Ireland Ltd, 2013) Taner, Alpaslan; Ünlü, Ali; Kayrak, Mehmet; Tekinalp, Mehmet; Ayhan, Selim Suzi
    Background: An increased prevalence of masked hypertension (MHT) has been demonstrated among patients with diabetes mellitus (DM). MHT appears to cause cardiovascular (CV) complications similar to clinically overt hypertension. Asymmetric dimethylarginine (ADMA) is an endogenous nitric oxide inhibitor and higher plasma levels of ADMA are related to increased CV risk in both the general population and among patients with DM. The aim of this study was to evaluate the relationship between MHT and ADMA in diabetic patients. Methods: This study included DM patients (n = 131) with normal office blood pressure (<140/90 mmHg). None of the participants were using antihypertensive medications. All participants utilized an ambulatory blood pressure monitor (ABPM) for 24 h. Serum ADMA and arginine levels were measured using the fluorescence detector high performance liquid chromatography method. Results: The prevalence of MHT was 24.4% among the study subjects. ADMA levels were increased in the MHT group when compared with normotensive diabetics (6.2 +/- 2.2 vs 4.2 +/- 1.7 mu mol/L p = 0.001, respectively). Furthermore, arginine/ADMA ratio was lower in the MHT group than among the normotensive group (29.9 +/- 12.1 vs 46.0 +/- 19.0 p = 0.001). In the multivariate logistic regression model, ADMA, BMI and HDL levels were found to be independent predictors of MHT Odds ratio: 1.63 (1.28-2.06), 1.19 (1.05-1.35), and 0.95 (0.90-0.99), respectively. The cut-off value of the ADMA was 4.34 mu mol/L with a sensitivity, specificity, positive predictive value, and negative predictive value of 84.4%, 59.6%, of 40.3%, and 92.2%, respectively (AUC - 0.78). Conclusions: Serum ADMA may play a role in both the pathophysiology and screening of MHT in DM subjects. (C) 2013 Elsevier Ireland Ltd. All rights reserved.