Raised Ambulatory Blood Pressure in Type 1 Diabetes with Incipient Microalbuminuria

Abstract

Whether raised blood pressure precedes, follows or develops in parallel with the onset of microalbuminuria, remains unclear. Previous studies, using conventional blood pressure recordings, have yielded discrepant results. Ambulatory blood pressure (ABP) monitoring detects borderline hypertension more reliably, and correlates more closely with end-organ damage. We have therefore compared ABP and left ventricular dimensions in normotensive insulin-dependent diabetic patients with or without microalbuminuria, and matched nondiabetic control subjects. Those diabetic patients with microalbuminuria, and to a lesser extent those without, had higher 24 h mean arterial blood pressure than matched non-diabetic control subjects, with corresponding increases of left ventricular mass, interventricular septal width and posterior wall thickness. These observations suggest that raised arterial blood pressure is present at an early stage of 'incipient' microalbuminuria.

Ambulatory blood pressure and heart rate in relation to kidney structure and metabolic control in adolescents with Type I diabetes

“…We therefore believe that the rise in BP precedes persistent microalbuminuria. This is in accord with the findings of other authors who measured 24-h AMBP [7,31,63]. Studies of casual BP have suggested that microalbuminuria develops parallel to the rise in BP [64].…”

Non‐dipping circadian blood pressure and renal impairment are associated with increased mortality in diabetes mellitus

“…If day‐to‐day blood pressure load over a prolonged period of time confers cardiovascular and renal risk, ambulatory blood pressure recording may theoretically be better at predicting this risk than casual clinic blood pressure recordings. Ambulatory blood pressure monitoring has previously identified variations in circadian blood pressure in both patients with essential hypertension[6–8] and diabetes mellitus[9,10] in relation to cardiac and renal outcomes. Whilst these are short‐term studies associating circadian blood pressure to changes in cardiac dimensions and renal function, there are very few long‐term outcome data available to allow an evaluation of the prognostic significance of alterations in circadian variation of blood pressure.…”

Circadian changes in blood pressure and their relationships to the development of microalbuminuria in type 1 diabetic patients

“…Over the last decade, many cross-sectional studies have been published addressing the relationship between ABPM and microalbuminuria in type 1 diabetic patients [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]. In 1992, Moore et al [9] studied 38 normotensive adolescent type 1 diabetic patients and found that in subjects with microalbuminuria, the nocturnal decrease was blunted but the difference did not reach statistical significance when compared with normoalbuminuric subjects.…”

“…Studies over the last decade have shown that in type 1 diabetic patients, early kidney involvement, reflected by the presence of microalbuminuria, is often associated with an increase in blood pressure, particularly during sleep [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]. Do these changes in blood pressure precede increases in urinary albumin excretion (UAE) or are they concurrent?…”