Morning home blood pressure may be a significant marker of nephropathy in Japanese patients with type 2 diabetes: ADVANCED-J study 1

Abstract

A 3-year multicenter, prospective, randomized, open-label trial (ADVANCED-J) compared the effect of an increased dose of angiotensin-II receptor blocker (ARB) with that of a maintenance dose of ARB plus calcium channel blocker (amlodipine) on blood pressure (BP) control, nephropathy and atherosclerosis in patients with type 2 diabetes and hypertension in whom the usual ARB dose failed to control BP. A cross-sectional analysis using baseline data was conducted. Of 316 patients (recruited between September 2004 and December 2005), 228 patients were evaluated by multiple regression analysis using two models after randomization and exclusions. Model 1 assessed 13 baseline variables (age, sex, estimated diabetes duration, estimated hypertension duration, HbA1c, brain natriuretic peptide (BNP), high-sensitive C-reactive protein (hsCRP), triglycerides (TGs), total cholesterol (TCHO), diabetic retinopathy (DMR), systolic morning home BP (HBP), diastolic morning HBP and brachialankle pulse wave velocity (baPWV)) for correlation with the urinary albumin creatinine excretion rate (UACR). In model 2, systolic and diastolic morning HBP was replaced by systolic and diastolic office BP. The systolic morning HBP and systolic office BP or diastolic morning HBP and diastolic office BP correlations were weak, but significant (r¼0.43 and 0.48, respectively). BNP, HbA1c, DMR and estimated diabetes duration were significantly correlated with UACR in both models 1 and 2. Although systolic office BP did not show a significant correlation with UACR in model 2, systolic morning HBP showed a significant correlation with UACR in model 1. Morning HBP, but not office BP, may be a significant marker of nephropathy in Japanese patients with type 2 diabetes.

B-type natriuretic peptide and renal function in Japanese patients with type 2 diabetes mellitus: The Dogo Study

“…In a Japanese study of normotensive, lean patients with type 2 diabetes mellitus, BNP level was positively associated with UACR [5]. A positive association between BNP level and UACR was found in a Japanese study of 316 patients with type 2 diabetes mellitus [6]. In a Japanese study of 233 patients with type 2 diabetes mellitus, BNP level was positively associated with macroalbuminuria [7].…”

“…In previous epidemiological studies regarding the association BNP and renal function, plasma BNP ranged from 10.8 to 46.3 ng/dL [5][6][7][8][9]. The discrepancies among these studies may be explained, at least in part, by differences in sample size; the definition of renal function; characteristics such as age, sex, race, BMI, prevalence of coronary heart diseases, subclinical heart failure and hypertension; and other confounding factors.…”

“…In a Japanese study, BNP levels among diabetic patients with microalbuminuria were higher than in those without [5]. BNP level was significantly positively associated with urinary albumin-creatinine ratio (UACR) in a Japanese study of patients with type 2 diabetes mellitus [6]. In a Japanese study of diabetic patients without coronary heart diseases, BNP level was positively associated with macroalbuminuria but not microalbuminuria [7].…”

Systolic blood pressure as a predictor of incident albuminuria and rapid renal function decline in type 2 diabetic patients

“…Furthermore, albuminuria has been directly linked to the risk of adverse cardiovascular outcomes and mortality, independent of other risk factors (Stephen et al, 2014), and may hence represent a potential target to improve cardiovascular and renal outcomes (Basi & Lewis, 2006;de Zeeuw, 2007;de Zeeuw et al, 2004;Holtkamp et al, 2011). Previous studies have indicated that significant predictors of progressive albuminuria include male sex, older age, obesity, hyperglycemia, hypertension, dyslipidemia, and baseline albuminuria (Bash, Selvin, Steffes, Coresh, & Astor, 2008;Jindal et al, 2013;Lin et al, 2009;Scheven et al, 2013;Tanaka et al, 2009). Moreover, a recent cross-sectional study, conducted among 9,579 middle-aged and elderly Chinese participants with normal urinary albumin excretion, reported that the UACR significantly correlated with metabolic syndrome and its components.…”

Association of Cardio-Ankle Vascular Index with Brain Natriuretic Peptide Levels in Hypertension

“…Clinical investigations of BNP have focused on its use in diagnosing heart failure and left ventricular hypertrophy and dysfunction 2,3) ; however, the Framingham Heart Study 4) demonstrated that plasma BNP levels predicted the risk of death and cardiovascular events in a community-based sample of individuals without heart failure. Thus, BNP has recently been well used in antihypertensive treatment to assess hypertensive target organ damage 5) and risk stratification 6) in patients without heart failure. Several studies 7,8) have demonstrated that antihypertensive treatment decreased plasma BNP levels and could be used as a biochemical marker of effective blood pressure control.…”