Familial hypertension and albuminuria in normotensive type I diabetic patients.

Abstract

An inherited predisposition to hypertension may increase susceptibility to nephropathy in type I diabetes. We evaluated the influence of a family history of essential hypertension on albuminuria in normotensive, normoalbuminuric type I diabetic patients. Forty-two diabetics (12.9±2.04 years) were divided into three groups according to tertiles of albumin excretion rate (group 1,1.27+0.35; group 2, 2.43±0.49; group 3, 6.37±3.43 jig/min; P<.001). Familial hypertension was considered to be present if the patient had one parent or grandparent on antihypertensive therapy. The three groups did not differ concerning age, diabetes duration, insulin requirement, body mass index, blood pressure, and urinary glucose excretion. Albumin excretion rate did not correlate with any parameter studied. The frequency of hypertension was significantly lower among the relatives of the patients from group 1 compared with those from groups 2 and 3 (28.6% versus 64.3% versus 78.6%, P<.03). Our data suggest that a familial antecedent of hypertension in normoalbuminuric type I diabetic patients is associated with a high normal albumin excretion rate not related to increases in blood pressure. Early changes in renal hemodynamics, seen in patients with a predisposition to hypertension, may contribute to increments in albuminuria even within the normal range. (Hypertension. 1994^3[suppl I]:I-256-I-258.)Key Words • diabetes mellitus, insulin-dependent • hypertension, essential • albuminuria • diabetic nephropathies R ecent studies have suggested that an inherited predisposition to essential hypertension (EH) may increase susceptibility to nephropathy in insulin-dependent diabetes mellitus (IDDM) based on the following arguments: (1) Nondiabetic parents of IDDM patients with nephropathy have higher blood pressure than parents of patients without proteinuria 1 ; (2) the rates of sodium-lithium countertransport, a marker of risk for EH, 2 have been found to be elevated in IDDM patients in whom the renal disease was developing 3 -4 ; and (3) hyperactrvity of Na-Li countertransport is also observed in diabetic patients even before the onset of nephropathy and is associated with hyperfiltration. 5 In fact, the influence of familial antecedents for EH on renal hemodynamics and sodium handling was evidenced by the comparison of normotensive IDDM offspring of hypertensive and nonhypertensive parents.6 However, possible influences on urinary albumin excretion in those patients without nephropathy were not investigated.This study evaluated the influence of a familial predisposition to EH on the albumin excretion rate (AER) in normotensive normoalbuminuric IDDM patients. aged 12.9±2.04 years, participated in this study after their parents' consent was obtained. IDDM duration ranged between 1.5 and 12 years. All patients were normoalbuminuric (as defined by AER < 15 /ig/min) and normotensive. Blood pressure was considered normotensive when systolic levels were less than 130 and diastolic levels less than 85 mm Hg over three recordings using a sta...

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