Ambulatory blood pressure monitoring and microalbuminuria in normotensive subjects with insulin-dependent diabetes mellitus

Cohen, C.; Fo, Francisco Manes Albanesi; Gonçalves, Maria Eduarda; Gomes, Marı́lia B.

doi:10.1590/s0066-782x2000000900001

Cited by 7 publications

(10 citation statements)

References 20 publications

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“…These findings suggest that crude increases in ambulatory nighttime BP compared to the nondipping phenomenon are more relevant in identifying diabetic patients at increased risk of microvascular complications [63]. Similar microalbuminuria-oriented findings were endorsed in adult [68] and pediatric [69] type 1 diabetic patients, further confirming the comparative predominance of absolute nighttime BP over circadian BP variability [70,71]. By contrast, the superiority of nondipping status over nighttime BP on microalbuminuria can be supported only by two small studies – the first recruiting 79 normotensive subjects and the latter 29 children with chronic renal failure [72,73].…”

Section: Introductionmentioning

confidence: 62%

Comparative Prognostic Role of Nighttime Blood Pressure and Nondipping Profile on Renal Outcomes

et al. 2011

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Different studies have addressed the predictive role of nighttime hemodynamics on cardiovascular and renal outcomes, although nocturnal blood pressure (BP) phenotypes (i.e. nondipping pattern and absolute nocturnal BP) have been found to be predictive of worse health outcomes. Furthermore, differences in both examined populations – ranging from healthy and younger subjects to those with overt cardiovascular disease – and study design (i.e. cross-sectional or longitudinal) make the interpretation of the suggested correlations difficult. Focusing on the kidney, we reviewed the literature addressing the impact of nocturnal BP phenotypes on renal outcomes in different populations by further dividing our search by study design. The evidence so far qualifies absolute nocturnal BP as a better predictor or determinant of kidney dysfunction as compared with the nondipping status. The magnitude of nocturnal hemodynamic load imposed at the glomerular level might be of higher prognostic value as compared with the integration of the pathophysiological mechanisms associated with impaired nocturnal BP variability. These findings underline the importance of nocturnal BP phenotypes, retrieved by ambulatory BP measurements, on age-dependent progressive kidney function decline and question whether, to what extent and in whom the reduced nocturnal BP or reverse nondipping BP profile to a normal pattern will be of benefit.

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Section: Introductionmentioning

confidence: 62%

Comparative Prognostic Role of Nighttime Blood Pressure and Nondipping Profile on Renal Outcomes

et al. 2011

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“…There was no statistical difference in systolic, diastolic, and mean nondippers between microalbuminuric and normoalbuminuric patients. Cohen et al [13] observed a lower but an insignificant decline of nighttime BP in micro-normoalbuminuric patients.…”

Section: Discussionmentioning

confidence: 94%

“…Lurbe et al [4] revealed that an increase in blood pressure during sleep, detected by ambulatory blood pressure monitoring, preceded the development of microalbuminuria and stated that an early increase in nighttime arterial blood pressure may have a key role in the development of diabetic nephropathy. Cohen et al [13] showed higher mean pressure values during day and nighttime in microalbuminuric diabetic adults. In adolescents any elevation of albumin excretion even above the upper limit of normal is associated with higher prevalence of elevated BP levels, and elevation of diastolic BP more than 22% is a greater risk of albuminuria [12].…”

Section: Discussionmentioning

confidence: 94%

Alterations of blood pressure in type 1 diabetic children and adolescents

et al. 2006

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The aim of this study was to assess the association between metabolic control, microalbuminuria, and diabetic nephropathy with ambulatory blood pressure monitoring (ABPM) in normotensive individuals with type 1 diabetes mellitus (DM). ABPM was undertaken in 68 normotensive type 1 diabetic patients with a mean age of 14.4+/-4.2 years. Microalbuminuria was diagnosed on the basis of a urinary albumin excretion rate grater than 20 microg/min in two of the three 24-h urine collections. Hypertension (HT) frequency was greater in the microalbuminuric patients than normoalbuminuric patients (54 vs 17.54%, p=0.05) with ABPM. Microalbuminuric patients had a higher diastolic pressure burden than normoalbuminuric patients. There were no differences in systolic and diastolic dips between the two groups. Diastolic pressure loads in all periods showed a significant correlation with duration of diabetes, mean HbA1c from the onset of diabetes, and level of microalbuminuria. Nocturnal dipping was reduced in 41.2% of the patients. In the normoalbuminuric group 41.1% and in the microalbuminuric group 63.6% were nondippers. Our data demonstrate higher 24-h and daytime diastolic blood pressure load and loss of nocturnal dip in type 1 diabetic adolescents and children. High diastolic blood pressure burden in diabetic patients could represent a risk for nephropathy.

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“…The existence of an association between greater pressure loads and increased UAE was demonstrated in patients with DM Type 1 44,45 and Type 2 13 . Recently, correlations between pressure loads and UAE, left ventricular mass, interventricular thickness, and left posterior ventricular wall in Type 2 DM patients 41 were demonstrated by our group.…”

Section: Pressure Loads and Diabetes Mellitusmentioning

confidence: 91%

“…Most studies that analyzed this ABPM parameter focused on the development and progression of DN. Some authors found positive results 35,40,[52][53][54][55][56] , while others were not able to establish this relationship 44,57,58 . Most studies were carried out crosssectionally or with cases and controls, merely suggesting an association between the factor under study (nocturnal BP fall) and the outcome (DN), and some presented statistical analysis and data interpretation susceptible to criticism 54,55 .…”

Section: Masked Hypertension (%)mentioning

confidence: 96%

Monitorização ambulatorial da pressão arterial e diabete melito tipo 2

Leitão¹,

Canani²,

Silveiro³

et al. 2007

Arq. Bras. Cardiol.

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SummaryHypertension is one of the main risk factors for the onset and progression of chronic complications in type 2 diabetes mellitus (DM).Ambulatory blood pressure (BP) monitoring (ABPM) provides a better correlation with target organ lesions than BP obtained in the office. Furthermore, it allows the evaluation of distinct BP parameters such as the 24-h, daytime and nighttime systolic and diastolic BP means, BP loads and the absence of nocturnal drop of BP, as well as the identification of white-coat and masked hypertension.DM patients have higher daytime and nighttime BP means than non-DM patients. In addition, one third of normotensive type 2 DM patients have masked hypertension, which is associated with an increase in albuminuria and in left ventricle wall thickness. On the other hand, the prevalence and effect of white-coat hypertension in type 2 DM patients have not yet been properly evaluated. The absence of nocturnal drop of BP does not add information to the 24 h, daytime or nighttime BP measurements, but the nighttime BP means seem to be relevant in DM retinopathy.In conclusion, BP determination by ABPM allows better patient risk stratification for the development of DM chronic complications and is an essential instrument for effective BP control in these patients. Arterial pressure and diabetes mellitusType 2 diabetes mellitus (DM) is associated with the development of chronic microvascular and macrovascular complications with high rates of morbidity and mortality 1,2 . The classic and most analyzed risk factors for the development and progression of chronic DM complications are DM duration, hyperglycemia, arterial hypertension (AH), dyslipidemia, and smoking, besides genetic factors [3][4][5][6][7][8] . The treatment of hyperglycemia and SAH results in primary prevention and reduction of the progression of diabetic retinopathy (DR) and diabetic nephropathy (DN) 9,10

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Ambulatory blood pressure monitoring and microalbuminuria in normotensive subjects with insulin-dependent diabetes mellitus

Abstract: Objective -To assess the association between microalbuminuria with ambulatory blood pressure monitoring in normotensive individuals with insulin-dependent diabetes mellitus. Methods -

Cited by 7 publications

References 20 publications

Comparative Prognostic Role of Nighttime Blood Pressure and Nondipping Profile on Renal Outcomes

Comparative Prognostic Role of Nighttime Blood Pressure and Nondipping Profile on Renal Outcomes

Alterations of blood pressure in type 1 diabetic children and adolescents

Monitorização ambulatorial da pressão arterial e diabete melito tipo 2

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