Ambulatory Blood Pressure in the Transition from Normo- to Microalbuminuria: A Longitudinal Study in IDDM Patients

Abstract

To describe the development in blood pressure (BP) in relation to urinary albumin excretion (UAE) more exactly, 44 initially normoalbuminuric type I diabetic patients and 21 healthy individuals were included in a 3.1-year follow-up study by using ambulatory BP (AMBP) monitoring. Six patients developed microalbuminuria according to accepted criteria (progressors; UAE at follow-up was > 20 micrograms/min). Initial UAE was higher in this group (9.0 x/divided by 1.4 micrograms/min) compared with both the nonprogressors (5.2 x/divided by 1.6 micrograms/min) and the control subjects (3.9 x/divided by 1.6 micrograms/min), P < 0.01. The values were almost identical for initial 24-h AMBP between the progressors and the two other groups. The transition to microalbuminuria (31.7 x/divided by 1.8 micrograms/min) was associated with an increase in 24-h systolic AMBP of 11.5 +/- 8.3 mmHg, which was significantly higher than the increase in the nonprogressors (3.1 +/- 7.7 mmHg) and the control subjects (2.2 +/- 6.1 mmHg, P = 0.02). Significant correlations were detected between development in UAE and development in systolic and diastolic 24-h AMBP (r = 0.39, r = 0.41, P < 0.01). In addition, an increase in UAE, even including increases within the normoalbuminuric range, was always associated with an increase in 24-h AMBP (P < 0.01). Ordinary clinical measurements did not reveal any of these differences or correlations. In conclusion, a close association between increases in UAE and 24-h AMBP emerges in this study. Initial BP was not increased in the progressors.(ABSTRACT TRUNCATED AT 250 WORDS)

Factors associated with progression to macroalbuminuria in microalbuminuric Type 1 diabetic patients: the EURODIAB Prospective Complications Study

“…It has also been observed that an increase in AER values in Type 1 diabetic subjects may be heralded by an abnormal pattern of night-time blood pressure [39]. We cannot, therefore, rule out that differences in blood pressure at baseline may not have been detectable with a single office measurement, but could have been found if 24-h blood pressure measurements had been performed [40,41]. However, at follow-up, systolic blood pressure and the use of anti-hypertension medications were higher in patients who had progressed to macroalbuminuria.…”

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).…”