Can ambulatory blood pressure monitoring (ABPM) help refine vascular risk assessment in type 2 diabetes mellitus (T2DM)? A cross-sectional observational analysis published in Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy evaluated the association between ABPM-derived blood pressure parameters and carotid plaque presence, with stratification by glycemic status.

The analysis included 498 patients with T2DM who underwent 24-hour ABPM and carotid ultrasound. Participants were grouped by glycated hemoglobin (HbA1c) levels into <5.7%, 5.7-6.4%, and ≥6.4%. Multivariable logistic regression assessed associations after adjustment for age, sex, body mass index, history of hypertension, smoking, alcohol consumption, marital status, and education. Sensitivity and subgroup analyses were performed to confirm consistency across clinical subsets.

Carotid plaques were present in 46.6% of the cohort. After adjustment, elevated systolic blood pressure (SBP) on ABPM was associated with plaque presence only in the HbA1c ≥6.4% group. The odds ratios were 2.14 (95% CI 1.30-3.56) for 24-hour SBP ≥130 mmHg, 1.87 (95% CI 1.14-3.11) for awake SBP ≥135 mmHg, and 1.78 (95% CI 1.08-2.95) for asleep SBP ≥120 mmHg. No significant associations were observed for diastolic blood pressure or in lower HbA1c categories.

These findings indicate that elevated SBP measured by ABPM is associated with carotid plaque presence in individuals with poorly controlled T2DM, supporting the combined assessment of ABPM and HbA1c for early vascular risk evaluation.