Left Ventricular Hypertrophy in Diabetic Patients

In their article entitled "Left Ventricular Mass in Diabetes Hypertension," Grossman et al 1 suggest that diabetes mellitus accelerates the development of left ventricular hypertrophy in patients with essential hypertension independent of arterial pressure. They also mention lack of correlation between duration of hypertension and left ventricular mass index in hypertensive diabetic patients. The correlation between casual blood pressure measurement and echocardiographic left ventricular hypertrophy is inadequate. 2 Furthermore, it has been suggested that end-organ damage is related to the frequency of abnormal pressure measurements rather than random or average blood pressure. 3 In unselected hypertensive patients, an ambulatory blood pressure decline from day to night is associated with a lower left ventricular mass. 4 Ambulatory blood pressure monitoring in patients with type 1 and type 2 diabetes reveals a lack of the normal nocturnal decline of blood pressure. 5,6 This observation could be related to autonomic nerve dysfunction and