[Relationship of hypertension and microalbuminuria in type 1 diabetes]

Hypertension and microalbuminuria are considered major cardiovascular risk factors in young patient with type 1 diabetes. The lack of nocturnal decrease of arterial blood pressure observed in the analysis of circadian blood pressure profile, could be an additional risk factor for progression of diabetic nephropathy.

Study included 112 patients with type 1 diabetes mellitus and hypertension from Nutrition and Metabolic Disease Center Iaşi. Patients were evaluated in terms of automatic blood pressure monitoring (ABPM) and for presence of microalbuminuria.

The results indicate that most patients with type 1 diabetes mellitus with an age of at least 5 years had microalbuminuria. 67.5% of patients with type 1 diabetes and hypertension had non-dipper blood pressure profile. Risk of progression of microalbuminuria was increased in patients with non-dipper profile. Nocturnal and daytime diastolic blood pressure average mean and nocturnal systolic blood pressure was significantly higher in the group with microalbuminuria compared to patients with normal urinary albumin excretion. Results of multivariate analysis indicate predictive factors for dipper/non-dipper blood pressure profile like microalbuminuria, lipid imbalance, HbA1c, diabetes duration, insulinoterapy scheme.

In the early stages of hypertension in type 1 diabetes, its systolic values are well correlated with the presence of microalbuminuria. Ambulatory blood pressure monitoring revealed association between microalbuminuria and non-dipper phenomenon. An early increase in nocturnal systolic blood pressure may have a key role in tracking the progression to diabetic nephropathy. This change is potentially useful as a marker of renal disease and initiation of nephroprotective therapy.