Endothelial dysfunction, ambulatory pulse pressure and albuminuria are associated in Type 2 diabetic subjects

Knudsen, S. T.; Jeppesen, Peter; Frederiksen, Christian Alcaraz; Andersen, Niels Holmark; Bek, Toke; Ingerslev, Jørgen; Ce, Mogensen; Poulsen, Per L.

doi:10.1111/j.1464-5491.2007.02197.x

Cited by 18 publications

(15 citation statements)

References 33 publications

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“…First, what are the underlying pathophysiological mechanisms connecting the haemodynamic abnormalities, elevated PP and blunted nocturnal BP decline, with the development of microvascular complications, in casu progression of nephropathy in type 2 diabetes? We have previously demonstrated strong associations between endothelial perturbation and both non-dipping [17] and elevated PP [5], suggesting that an enhanced level of endothelial cell activation could represent a link between these haemodynamic abnormalities and the development of microvascular complications in type 2 diabetes, possibly by promoting inflammation and atherosclerosis and by increasing the tendency of blood clotting. However, we were unable to make firm conclusions regarding causality due to the cross-sectional design of the studies.…”

Section: Discussionmentioning

confidence: 97%

“…Numerous previous studies have established the superiority of 24 h AMBP over conventional office BP measurement for the association with [1,5,15,32,33] and prediction of hypertensive end-organ damage in diabetes [9,34,35]. Moran et al found that office and 24 h systolic AMBP were independently associated with albuminuria in elderly type 2 diabetic patients [4]; however in the longitudinal study mentioned above [9], ambulatory PP predicted progression of albuminuria above and beyond office BP.…”

Section: Discussionmentioning

confidence: 98%

“…Although the crosssectional design did not allow any firm conclusions regarding causality, we hypothesised that PP could be a risk factor for the progression of albuminuria in this patient group. Subsequently, several studies have associated an elevated PP with both micro- [3,5] and macrovascular [6][7][8] complications in diabetic patients.…”

Section: Discussionmentioning

confidence: 99%

“…An elevated pulse pressure (PP) is strongly associated with micro- [1][2][3][4][5] as well as macrovascular [1,[6][7][8] complications in type 2 diabetic patients. In a large observational study including 954 elderly type 2 diabetic patients [9], ambulatory PP was a strong and independent predictor of progression of nephropathy during a 2 year follow-up period.…”

Section: Introductionmentioning

confidence: 99%

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Ambulatory pulse pressure, decreased nocturnal blood pressure reduction and progression of nephropathy in type 2 diabetic patients

et al. 2009

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Aims/hypothesis We followed type 2 diabetic patients over a long period to evaluate the predictive value of ambulatory pulse pressure (PP) and decreased nocturnal BP reduction (non-dipping) for nephropathy progression. Methods Type 2 diabetic patients (n=112) were followed for an average of 9.5 (range 0.5-14.5) years. At baseline, all patients underwent 24 h ambulatory BP measurement. Urinary albumin excretion rate was evaluated by three urinary albumin:creatinine ratio measurements at baseline and follow-up. Results At baseline, patients who subsequently progressed to a more advanced nephropathy stage (n=35) had reduced diastolic night/day BP variation and higher 24 h systolic BP and PP values; they also had more advanced nephropathy and were more likely to smoke than those with no progression of nephropathy (n=77). In a Cox regression analysis, independent predictors of nephropathy progression were 24 h PP (p<0.01), diastolic night:day BP ratio (p=0.02) and smoking (p=0.02). The adjusted hazards ratio (95% CI) for each mmHg increment in 24 h PP was 1.04 (1.01-1.07), whereas the adjusted hazards ratio (95% CI) for each 1% increase in diastolic night:day BP ratio was 1.06 (1.01-1.11). Only one of 33 patients (3.0%) with both a diastolic night:day BP ratio and a 24 h PP below the median progressed, whereas 17 of 32 patients (53.1%) with both a diastolic night:day BP ratio and a 24 h PP equal to or above the median progressed to a more advanced nephropathy stage (p<0.001). Conclusions/interpretation Ambulatory PP, impaired nocturnal BP decline and smoking are strong, independent predictors of nephropathy progression in type 2 diabetic patients.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Ambulatory pulse pressure, decreased nocturnal blood pressure reduction and progression of nephropathy in type 2 diabetic patients

et al. 2009

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“…14 Increased UAE has also been associated with proinflammatory markers [14][15][16] and arterial stiffness [17][18][19][20] in older adults and in adults with cardiovascular disease and diabetes. The clinical data demonstrate a consistent significant association of increases in UAE with progression in cardiovascular and renal injury.…”

Section: Introductionmentioning

confidence: 99%

Risk factors associated with urinary albumin excretion in African Americans

et al. 2010

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Microalbuminuria is considered a marker of heightened risk for cardiovascular events. We examined cardiovascular risk factors, including inflammatory cytokines, which contribute to urinary albumin excretion (UAE) in a cross-sectional study of African Americans aged 18-49 years. Measurements included a timed overnight urine collection for UAE, blood pressure (BP), body mass index, glucose, lipids, insulin and inflammatory cytokines. Non-normally distributed variables were log transformed for analysis using multiple linear regressions. Data were obtained from 488 participants with mean age 37.8 years; 50% were obese, 42% had hypertension. Log UAE correlated significantly with systolic BP (SBP) (geometric mean ratio ¼ 1.011; 95% confidence interval 1.003-1.019). When subjects were stratified into four UAE groups, the only variables significantly different between groups were SBP (P ¼ 0.013) and diastolic BP (P ¼ 0.036). There were no statistically significant associations with obesity, metabolic parameters, insulin resistance or any inflammatory cytokines identified. In young, relatively healthy, African Americans, BP level is significantly associated with levels of UAE even below the threshold for microalbuminuria. The presence of diabetes and insulin resistance in the absence of high BP did not seem to contribute significantly to UAE in this cohort.

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Current literature in diabetes

2008

Diabetes Metabolism Res

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In order to keep subscribers up‐to‐date with the latest developments in their field, John Wiley & Sons are providing a current awareness service in each issue of the journal. The bibliography contains newly published material in the field of diabetes/metabolism. Each bibliography is divided into 26 sections: 1 Reviews; 2 General; 3 Genetics; 4 Epidemiology; 5 Immunology; 6 Obesity; 7 Prediction and Prevention; 8 Intervention: a) General; b) Care; c) Drug Therapy; d)Economics; e) Gene therapy; f) Nursing; g) Nutrition; h) Surgery; i) Transplantation; 9 Pathology and Complications: a) General; b) Cardiovascular; c) Eye disease; d) Gestational and fetal; e) Neurological; f) Podiatrical; g) Renal; 10 Endocrinology & Metabolism; 11 Experimental Studies; 12 Diagnosis and Techniques. Within each section, articles are listed in alphabetical order with respect to author

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Endothelial dysfunction, ambulatory pulse pressure and albuminuria are associated in Type 2 diabetic subjects

Cited by 18 publications

References 33 publications

Ambulatory pulse pressure, decreased nocturnal blood pressure reduction and progression of nephropathy in type 2 diabetic patients

Ambulatory pulse pressure, decreased nocturnal blood pressure reduction and progression of nephropathy in type 2 diabetic patients

Risk factors associated with urinary albumin excretion in African Americans

Current literature in diabetes

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