Ambulatory blood pressure in microalbuminuric type 1 diabetic patients

Abstract

Twenty-four-hour ambulatory blood pressure (AMBP) was performed in microalbuminuric (micro.) type 1 diabetic patients, with the aim of comparison with a matched group of normoalbuminuric patients (normo.) and healthy controls. Thirty-four patients without antihypertensive medication were investigated in each group. Urinary albumin excretion (UAE) for micro. was (geometric mean, tolerance factor microgram/min) 51.7 x/divided by 1.94, 5.1 x/divided by 1.88 for normo. and 5.2 x/divided by 1.75 for controls. Twenty-four-hour AMBP (mean systolic/diastolic mm Hg +/- SD) was significantly higher in micro. (131 +/- 10/78 +/- 7) than in normo. (122 +/- 8/73 +/- 6; P less than 0.001/P less than 0.01). No 24-hour AMBP difference between normo. and controls (120 +/- 9/71 +/- 7) was found. No difference in the night/day ratio of blood pressure was found between the diabetic groups. Coefficient of variation for day time systolic measurements did not show any intergroup difference. Systolic day time blood pressure for the pooled diabetic group correlated significantly with UAE (r = 0.45, P less than 0.001), whereas no significant correlation with auscultatory systolic values in the clinic was found (r = 0.21; P = 0.09). In conclusion, blood pressure in micro. as compared to normo. is not more labile but is elevated day and night without significant alteration of the diurnal rhythm. AMBP reflects the association between UAE and blood pressure more precisely than clinical measurements and may be preferable for identifying candidates for antihypertensive treatment.

Non-dipping in diabetic patients: insights from the siesta

“…Several studies have shown that non-dipping may be a marker, heralding development of microalbuminuria and diabetic nephropathy. [13][14][15][16][17][18] The proposed pathogenic is devoid of interruptions, and thus can be used as a model for tiled, non-interrupted sleep. We found that, both in diabetic patients and controls, blood pressure declined during the afternoon nap in a similar magnitude to the night-time decline.…”

The impact of blood pressure measurement methods on the assessment of differences in blood pressure levels between patients with normoalbuminuric type 1 diabetes and healthy controls

“…In all but one study no difference in BP was observed between healthy controls and patients with normoalbuminuric type 1 diabetes, when adjusting for albuminuria, diabetes duration, age and gender. 3,4,11,12,14,16,[25][26][27] We have used an automatic auscultatory device (Profilomat ® ) to measure 24-h BPs and found no significant difference in 'daytime' or 'night-time' BP or in systolic or diastolic day-night differences between diabetic patients and controls. These results are somewhat in contrast with data from studies in which 24-h BPs were measured with an oscillometric device.…”

“…11 Although most cross-sectional as well as longitudinal studies on the prevalence of elevated BP in type 1 diabetes suggest an association between microalbuminuria and BP rise, it is still controversial whether the increase of arterial BP precedes, follows or develops in parallel with the onset of microalbuminuria. [2][3][4][5][6][13][14][15][16]23,24 These discrepancies on the prevalence of increased BP in type 1 diabetic patients at the onset of microalbuminuria can be attributed, at least partially, to differences in the study populations with respect to factors as age, diabetes duration, gender, sodiumintake, presence of autonomic neuropathy, the number of smokers vs non-smokers and urinary albumin excretion. However, from our data it is evident that differences in techniques of BP measurements should also be taken into account.…”

“…Although not found by all, most of these studies report an increased (mainly systolic) BP especially during the night or a decrease in systolic and diastolic day-night differences in patients with normoalbuminuric type 1 diabetes (Table 3). 14,16,[25][26][27][28][29][30][31] We are only aware of two reports in which auscultatory devices were used for measuring 24 h BPs. In both studies no difference in 24-h ambulatory BPs between patients with normoalbuminuric type 1 diabetes and healthy controls was found.…”

“…[1][2][3][4][5] Furthermore, it is unclear if in patients with type 1 diabetes an increase in BP precedes or follows the onset of microalbuminuria. 4,[6][7][8][9][10][11][12][13][14][15][16][17][18] It is clear that accurate measurements of BP are of great importance. In the various studies mentioned before, the methods of BP ± 1.5/83.7 ± 1.0 in C (NS).…”