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Ambulatory blood pressure in microalbuminuric type 1 diabetic patients
K W Hansen1, C K Christensen, P H Andersen
1Medical Department M Diabetes & Endocrinology, Aarhus Kommunehospital, Denmark.
Abstract:
Twenty-four-hour ambulatory blood pressure (AMBP) was performed in microalbuminuric (micro.) type 1 diabetic patients, with the aim of comparison with a matched group of normoalbuminuric patients (normo.) and healthy controls. Thirty-four patients without antihypertensive medication were investigated in each group. Urinary albumin excretion (UAE) for micro. was (geometric mean, tolerance factor microgram/min) 51.7 x/divided by 1.94, 5.1 x/divided by 1.88 for normo. and 5.2 x/divided by 1.75 for controls. Twenty-four-hour AMBP (mean systolic/diastolic mm Hg +/- SD) was significantly higher in micro. (131 +/- 10/78 +/- 7) than in normo. (122 +/- 8/73 +/- 6; P less than 0.001/P less than 0.01). No 24-hour AMBP difference between normo. and controls (120 +/- 9/71 +/- 7) was found. No difference in the night/day ratio of blood pressure was found between the diabetic groups. Coefficient of variation for day time systolic measurements did not show any intergroup difference. Systolic day time blood pressure for the pooled diabetic group correlated significantly with UAE (r = 0.45, P less than 0.001), whereas no significant correlation with auscultatory systolic values in the clinic was found (r = 0.21; P = 0.09). In conclusion, blood pressure in micro. as compared to normo. is not more labile but is elevated day and night without significant alteration of the diurnal rhythm. AMBP reflects the association between UAE and blood pressure more precisely than clinical measurements and may be preferable for identifying candidates for antihypertensive treatment.
Insights
Microalbuminuric type 1 diabetic patients have elevated 24-hour ambulatory blood pressure (AMBP) compared to normoalbuminuric patients. AMBP more accurately reflects the link between urinary albumin excretion (UAE) and blood pressure than clinical readings.
Area of Science:
- Nephrology
- Cardiology
- Endocrinology
Background:
- Microalbuminuria is a common complication of type 1 diabetes.
- Elevated blood pressure is a risk factor for diabetic nephropathy progression.
- The role of ambulatory blood pressure monitoring (AMBP) in microalbuminuric diabetes requires further investigation.
Purpose of the Study:
- To compare 24-hour AMBP in microalbuminuric type 1 diabetic patients with normoalbuminuric diabetic patients and healthy controls.
- To assess the relationship between urinary albumin excretion (UAE) and blood pressure parameters.
- To determine if AMBP is a more precise indicator of blood pressure elevation than clinic-based measurements.
Main Methods:
- Twenty-four-hour AMBP was conducted on 34 microalbuminuric diabetic patients, 34 normoalbuminuric diabetic patients, and 34 healthy controls, all without antihypertensive medication.
- Urinary albumin excretion (UAE) was measured in all participants.
- Blood pressure readings included systolic and diastolic measurements, day/night ratios, and coefficient of variation.
Main Results:
- Microalbuminuric patients exhibited significantly higher 24-hour AMBP (systolic/diastolic: 131/78 mmHg) compared to normoalbuminuric patients (122/73 mmHg).
- No significant difference in 24-hour AMBP was observed between normoalbuminuric patients and healthy controls (120/71 mmHg).
- Systolic daytime blood pressure in diabetic patients correlated significantly with UAE (r=0.45), a correlation not found with standard clinic measurements (r=0.21).
Conclusions:
- Microalbuminuric type 1 diabetic patients have elevated day and night blood pressure without altered diurnal rhythm compared to normoalbuminuric patients.
- AMBP provides a more precise reflection of the association between UAE and blood pressure than traditional clinical measurements.
- AMBP may be superior for identifying diabetic patients who would benefit from antihypertensive treatment.