Office and Ambulatory Blood Pressure Are Independently Associated With Albuminuria in Older Subjects With Type 2 Diabetes

Abstract

Abstract-Blood pressure strongly predicts microalbuminuria and later progression to renal failure in people with diabetes.Ambulatory blood pressure monitoring seems to be superior to office blood pressure in predicting progression to microalbuminuria in type 1 diabetes. The associations of ambulatory blood pressure with office blood pressure and microalbuminuria in type 2 diabetes remain unclear. We studied the association of office blood pressure taken with an automated device and ambulatory blood pressure with spot urine albumin:creatinine ratio in 1180 older people with type 2 diabetes participating in the Informatics for Diabetes Education and Telemedicine Study. Office and awake systolic blood pressure were independently associated with albuminuria (PϽ0.001 for both) in a multivariate linear regression analysis that adjusted for age, gender, duration of diabetes, hemoglobin A1c, number of antihypertensive medications, and use of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. Twelve percent of participants had well-controlled office blood pressure but not ambulatory blood pressure, whereas 14% had well-controlled ambulatory but not office blood pressure. The prevalence of microalbuminuria and macroalbuminuria in these subgroups was intermediate between those with well-controlled or uncontrolled blood pressure by both methods. We found, in a multiethnic group of older subjects with type 2 diabetes, that office systolic blood pressure and awake systolic ambulatory blood pressure exhibited independent associations with degree of albuminuria.

ACCF/AHA 2011 Expert Consensus Document on Hypertension in the Elderly

“…371 In older patients with type 2 diabetes mellitus, both high-office SBP and high-awake ambulatory SBP independently predict albuminuria. 372 …”

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

“…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. In the present study, none of the office BP values had any significant predictive value for the progression of nephropathy, whereas 24 h systolic AMBP and PP values were strong predictors of nephropathy progression in type 2 diabetic patients.…”

“…In particular, focus has been directed towards a blunted nocturnal BP reduction ('non-dipping'), a pattern that has been consistently associated with diabetic vascular complications in previous studies [1,[10][11][12][13][14][15][16][17]35]. In a 3 year follow-up of the same elderly type 2 diabetic patients mentioned above [4,9], the investigators found that patients with a reversed diurnal BP rhythm (nocturnal BP 'risers') had an increased risk of nephropathy progression compared with patients with a normal reduction in BP during nighttime ('dippers'), whereas patients with a reduced nocturnal BP decline ('non-dippers') had an intermediate risk of progression [19]. Nocturnal BP rising was an independent predictor of albuminuria progression in the multivariate analysis, whereas non-dipping did not independently predict albuminuria progression.…”

“…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.…”

Abnormalities in ambulatory blood pressure monitoring in hypertensive patients with diabetes

“…2,3 A series of reports dealing with diabetic patients have also shown a close correlation between ambulatory BP and diabetic complications. 4,5 Evidences are available for the entire cardiorenal continuum of diabetic damage from the prediction of microalbuminuria by early changes in nocturnal BP in type 1 patients 6 to the effect of a riser pattern on mortality in patients with type 2 diabetes. 7 Nevertheless, information about the ABPM characteristics of large cohorts of diabetic hypertensives attending primary care centers is scarce.…”