How often should BP be measured in diabetic patients What is the recommended method of followup

BP should be measured at diagnosis of DM and then at each doctor's visit. Due to the variability of its measurement, proper conditions and the right technique are of utmost importance for correct recording. The dimensions of the sphygmomanometer cuff should properly fit the size of the patient's arm - the length of the cuff should cover at least 80 percent of the circumference of the arm (bigger than needed cuffs will show false lower blood pressure values, whereas smaller cuffs will show false higher values. The systolic and diastolic blood pressures should also be measured in both arms the first time (and then the arm with the higher pressure should be used). The measurement should be performed both in a sitting and standing position (after at least 1 minute of standing) in order to exclude potential orthostatic hypotension - i.e., fall of systolic BP by 20 mmHg and/or of diastolic by 10 mmHg - which is not that infrequent in diabetic patients (the coexistence of supine hypertension with orthostatic hypotension is a difficult therapeutic problem that can require modification of the pharmaceutical regimen). The patient should rest quietly for at least 10 minutes before the measurement, should not have consumed alcohol, caffeine or nicotine for the previous half an hour and the room temperature should be normal. The BP should ideally be measured at least three times (with intervals of 1-2 min) and the mean of the last two measure- ments used for its recording. It is essential that the cuff deflation be performed slowly, at a rate of 2 mmHg per second during BP measurement.

Sometimes it is useful to record 24-hour ambulatory BP with the use of special equipment for automatic recording, in order to exclude the possibility of 'white-coat hypertension' as well as to diagnose the likely existence of 'not-falling' of BP during the night (non-dippers). This phenomenon increases the cardiovascular risk, even if the BP during the day is normal (it is more frequent in diabetic patients with nephropathy).

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