Pre-diabetic blood pressure predicts urinary albumin excretion after the onset of Type 2 (non-insulin-dependent) diabetes mellitus in Pima Indians

Abstract

Blood pressure was measured in 490 non-proteinuric Pima Indians from the Gila River Indian Community in Arizona at least 1 year before the diagnosis of Type 2 (non-insulin-dependent) diabetes mellitus. Urine albumin concentration was measured in the same subjects 0-24 years (mean 5 years) after diabetes was diagnosed. Prevalence rates of abnormal albumin excretion (albumin-to-creatinine ratio > or = 100 mg/g) after the onset of Type 2 diabetes were 9%, 16%, and 23%, respectively, for the lowest to highest tertiles of pre-diabetic mean blood pressure. When controlled for age, sex, duration of diabetes and pre-diabetic 2-h post-load plasma glucose concentration, higher pre-diabetic mean blood pressure predicted abnormal urinary excretion of albumin after the onset of diabetes. This finding suggests that the higher blood pressure seen in diabetic nephropathy is not entirely a result of the renal disease, but may precede and contribute to it.

Diabetes and Cardiovascular Disease

“…22 It increases risk for both CHD and stroke and contributes to diabetic nephropathy. 73 Several investigators 74,75 report a positive association between insulin resistance and hypertension; this finding suggests that elevated blood pressure deserves to be listed among the components of the metabolic syndrome. Hypertension nonetheless is a multifactorial disorder, and the mechanistic connections between insulin resistance and hypertension are largely conjectural; even so, evidence for a causal link is growing.…”

Segregation analysis of urinary albumin excretion in families with type 2 diabetes.

“…A corresponding heterogeneity in the determinants of the ACR level would also diminish power to identify major gene effects by segregation analysis. Although we have included duration of diabetes as a covariate (along with age and sex), we have not accounted for other correlates of ACR, such as blood pressure (38,39). However, given the strong genetic correlation between ACR and blood pressure, already demonstrated in this population, it is inappropriate to include blood pressure as a covariate in the segregation analysis.…”

Diabetic Nephropathy in Type 2 Diabetes Prevention and Patient Management

“…Pre-diabetic individuals with impaired glucose tolerance frequently have hypertension as one facet of the metabolic syndrome. In Pima Indians such pre-diabetic hypertension has been shown to be a predictor of diabetic nephropathy (5 yrs after onset of diabetes) (68). At the time when type 2 diabetes had been diagnosed but acute hyperglycemia had been reversed, abnormal ambulatory BP values (Ͼ 130/80 mmHg) or an abnormal circadian BP profile (Ͻ 15% nighttime decrease) was noted in 80% of the patients (15).…”