A Web-based telemedicine system can be a useful tool facilitating the management of pregnant diabetes patients, as a complement to conventional outpatient clinic visits.

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Abstract-The objective was to assess the temporal impact of factors related to the development of microalbuminuria during the follow-up of young adult normoalbuminurics with high-normal blood pressure or at stage 1 of essential hypertension. Prospective follow-up was conducted on 245 normoalbuminuric hypertensive subjects (mean age 40.9 years; 134 men; blood pressure 139.7/88.6 mm Hg; body mass index 28.5 kg/m 2 ) never treated previously with antihypertensive drugs, with yearly urinary albumin excretion measurements, until the development of microalbuminuria. After enrollment, patients were placed on usual care including nonpharmacological treatment or with an antihypertensive drug regime to achieve a blood pressure of Ͻ135/85 mm Hg. Thirty subjects (12.2%) developed microalbuminuria after a mean follow-up of 29.9 months (range 12 to 144 months), 2.5 per 100 patients per year. Baseline urinary albumin excretion (hazard ratio, 1.07; Pϭ0.006) and systolic blood pressure during the follow-up (hazard ratio, 1.03; Pϭ0.008) were independent factors related to the follow-up urinary albumin excretion in a Cox proportional hazard model. A significant increase in the risk of developing microalbuminuria for urinary albumin excretion at baseline Ͼ15 mg per 24-hour systolic blood pressure Ͼ139 mm Hg and a positive trend in fasting glucose were observed in the univariate analyses. However, in the multivariate analysis, only the baseline urinary albumin excretion and the trend of fasting glucose were independently related to the risk of developing microalbuminuria. In mild hypertensives, the development of microalbuminuria was linked to insufficient blood pressure control and to a progressive increment of glucose values. Key Words: hypertension, essential Ⅲ blood pressure Ⅲ glucose Ⅲ microalbuminuria D uring the last few years, microalbuminuria has become a prognostic marker for cardiovascular or renal risk in diabetic and nondiabetic subjects. 1-9 Although determinants of subtle increases in urinary albumin excretion (UAE) and its progression remain poorly understood, microalbuminuria assessment is now recommended in a risk stratification strategy for hypertension management. 10,11 Moreover, the potential of microalbuminuria as an intermediate end point during antihypertensive treatment is still unclear, although evidence is appearing. 12,13 A better understanding of what determines the development of microalbuminuria in hypertensives will help formulate a more rational application of microalbuminuria at the time of risk stratification as well as during treatment.Factors related to the presence of microalbuminuria in essential hypertension have been analyzed in cross-sectional studies. Microalbuminuria has been related to blood pressure (BP) values 14 -17 and to hyperinsulinemia as an expression of insulin resistance. 18,19 Obesity, 20 smoking, 21 and genetics 22,23 have also been implicated as determinants of microalbuminuria in some of the studies.Follow-up studies of microalbuminuria in essential hypertensives are rare, ...