Diabetes Care, Vol 18, Issue 11 1434-1441, Copyright © 1995 by American Diabetes Association

ARTICLES

Albuminuria and 24-h ambulatory blood pressure in normoalbuminuric and microalbuminuric NIDDM patients. A longitudinal study

S Nielsen, A Schmitz, PL Poulsen, KW Hansen and CE Mogensen
Medical Department M, Aarhus Kommunehospital, Denmark.

OBJECTIVE: To assess the long-term relationships between 24-h ambulatory blood pressure (AMBP), urinary albumin excretion (UAE) rate, and metabolic control in non-insulin-dependent diabetes mellitus (NIDDM) patients with normo- and microalbuminuria. RESEARCH DESIGN AND METHODS: We conducted a prospective study of 23 NIDDM patients (11 with normoalbuminuria and 12 with microalbuminuria) receiving standard clinical care, including antihypertensive treatment, attending the outpatient clinic and 8 healthy control subjects. Twenty-four-hour AMBP and UAE were measured synchronously in addition to fasting plasma glucose, HbA1c, and serum creatinine at baseline and after 4.6 (4.2-5.1) years [mean (range)]. RESULTS: Baseline systolic, but not diastolic, 24-h AMBP was significantly higher in diabetic patients compared with control subjects (146/80 [16/11] vs. 133/78 [9/9] mmHg, P < 0.05), but was similar in normoalbuminuric (143/81 [11/11] mmHg) and microalbuminuric (148/80 [20/10] mmHg) patients during strict blood pressure control. The annual increase in 24-h AMBP was equivalent in diabetic patients (0.6/-0.2 [2.6/1.5] mmHg/year) and control subjects (0.7/0.2 [1.2/1.4] mmHg/year, NS) and not significantly different from zero. Overall UAE did not change in control subjects (5.6 [1.6] vs. 4.4 [1.9]) (geometric mean [antilog SD]) or in the normoalbuminuric (8.7 [1.7] vs. 11.3 [3.0] micrograms/min) and microalbuminuric (35.7 [2.1] vs. 34.5 [3.2] micrograms/min) patients. In diabetic patients, the annual change in UAE correlated significantly with the annual change in the systolic (r = 0.61, P < 0.002) and diastolic (r = 0.54, P < 0.008) 24-h AMBP. In microalbuminuric patients, only the annual increase in systolic 24-h AMBP correlated significantly with the annual change in UAE (r = 0.71, P = 0.010), whereas in the normoalbuminuric patients, only the annual increase in diastolic 24-h AMBP and the annual change in UAE were significantly correlated (r = 0.66, P = 0.026). In a stepwise multiple linear regression analysis, the annual progression in albuminuria in NIDDM patients was significantly determined by increases in systolic (parameter estimate 0.018, SE 0.006, P < 0.008) as well as in diastolic 24-h AMBP (parameter estimate 0.026, SE 0.011, P < 0.033). CONCLUSIONS: In an outpatient clinical setting, 24-h AMBP is similar in NIDDM patients with normo- and microalbuminuria. Alterations in both 24-h AMBP and UAE are on average moderate and equivalent compared with those in healthy control subjects. Although the average change in albuminuria is small, a progression in albuminuria relates to increments in both systolic and diastolic 24-h AMBP.
CiteULike    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				W. Palmas, T. G. Pickering, J. Teresi, J. E. Schwartz, L. Field, R. S. Weinstock, and S. Shea Telemedicine Home Blood Pressure Measurements and Progression of Albuminuria in Elderly People With Diabetes Hypertension, May 1, 2008; 51(5): 1282 - 1288. [Abstract] [Full Text] [PDF]

				W. Palmas, A. Moran, T. Pickering, J. P. Eimicke, J. Teresi, J. E. Schwartz, L. Field, R. S. Weinstock, and S. Shea Ambulatory Pulse Pressure and Progression of Urinary Albumin Excretion in Older Patients With Type 2 Diabetes Mellitus Hypertension, August 1, 2006; 48(2): 301 - 308. [Abstract] [Full Text] [PDF]

				A. Moran, W. Palmas, T. G. Pickering, J. E. Schwartz, L. Field, R. S. Weinstock, and S. Shea Office and Ambulatory Blood Pressure Are Independently Associated With Albuminuria in Older Subjects With Type 2 Diabetes Hypertension, May 1, 2006; 47(5): 955 - 961. [Abstract] [Full Text] [PDF]

				A. Moran, W. Palmas, L. Field, J. Bhattarai, J. E. Schwartz, R. S. Weinstock, and S. Shea Cardiovascular Autonomic Neuropathy Is Associated With Microalbuminuria in Older Patients With Type 2 Diabetes Diabetes Care, April 1, 2004; 27(4): 972 - 977. [Abstract] [Full Text] [PDF]

				L. Poulsen Blood pressure and cardiac autonomic function in relation to risk factors and treatment perspectives in Type 1 diabetes Journal of Renin-Angiotensin-Aldosterone System, December 1, 2002; 3(4): 222 - 242. [Abstract] [PDF]

				A Melville, R Richardson, D Lister-Sharp, and A McIntosh Complications of diabetes: renal disease and promotion of self-management Qual. Saf. Health Care, December 1, 2000; 9(4): 257 - 263. [Full Text]