Increase in Nocturnal Blood Pressure and Progression to Microalbuminuria in Type 1 Diabetes

Lurbe, Empar; Redón, Josep; Kesani, Ajit; Pascual, J.M.; Tacons, Jose; Álvarez, Vicente; Batlle, Daniel

doi:10.1056/nejmoa013410

Cited by 655 publications

(471 citation statements)

References 36 publications

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“…It is possible that the increase in blood pressure in patients progressing to overt nephropathy is evident only in close temporal relationship with the increase in AER, and thus may have been missed in the 7-year follow-up interval. It has also been observed that an increase in AER values in Type 1 diabetic subjects may be heralded by an abnormal pattern of night-time blood pressure [39]. We cannot, therefore, rule out that differences in blood pressure at baseline may not have been detectable with a single office measurement, but could have been found if 24-h blood pressure measurements had been performed [40,41].…”

Section: Discussionmentioning

confidence: 92%

Factors associated with progression to macroalbuminuria in microalbuminuric Type 1 diabetic patients: the EURODIAB Prospective Complications Study

et al. 2004

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Aims/hypothesis. Type 1 diabetic patients who develop microalbuminuria are clearly disadvantaged in terms of their risk of morbidity and mortality from renal and cardiovascular diseases. It is therefore important to identify potential factors that can predict progression to macroalbuminuria. Methods. This is a 7-year follow-up study of 352 microalbuminuric Type 1 diabetic patients from 31 European centres. Risk factors at baseline were compared in patients who progressed to macroalbuminuria and in patients who remained microalbuminuric or reverted to normoalbuminuria. Risk factors and albumin excretion rate (AER) were measured centrally. Results. Over 7.3 years, 13.9% of the microalbuminuric patients progressed to macroalbuminuria, 35.5% remained microalbuminuric and 50.6% reverted to normoalbuminuria. Independent baseline risk factors for progression to macroalbuminuria were HbA 1 c (7.9% vs 6.8%, p=0.004), AER (64.4 vs 44.9 µg/min, p=0.0001) and-after adjusting for diabetes duration, HbA 1 c and AER-body weight (72 vs 67 kg, p=0.05). Independent factors associated with regression to normoalbuminuria were diabetes duration (15 vs 18 years, p=0.004), AER (37.2 vs 44.9 µg/min, p=0.0001) andafter adjusting for diabetes duration, HbA 1 c and AER-waist-to-hip ratio (0.83 vs 0.86, p=0.05) and incidence of peripheral neuropathy at baseline (24% vs 38%, p=0.001). Blood pressure and smoking did not emerge as risk factors at baseline for the outcome of microalbuminuria. Conclusions/interpretation. A significant fraction of microalbuminuric Type 1 diabetic patients will progress to overt proteinuria. Patients with higher AER values, sub-optimal metabolic control, excess body fat and peripheral neuropathy may carry a particularly high risk of clinical nephropathy requiring aggressive therapeutic intervention.

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Section: Discussionmentioning

confidence: 92%

Factors associated with progression to macroalbuminuria in microalbuminuric Type 1 diabetic patients: the EURODIAB Prospective Complications Study

et al. 2004

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“…2,3 A series of reports dealing with diabetic patients have also shown a close correlation between ambulatory BP and diabetic complications. 4,5 Evidences are available for the entire cardiorenal continuum of diabetic damage from the prediction of microalbuminuria by early changes in nocturnal BP in type 1 patients 6 to the effect of a riser pattern on mortality in patients with type 2 diabetes. 7 Nevertheless, information about the ABPM characteristics of large cohorts of diabetic hypertensives attending primary care centers is scarce.…”

Section: Introductionmentioning

confidence: 99%

Abnormalities in ambulatory blood pressure monitoring in hypertensive patients with diabetes

et al. 2011

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on behalf of the Spanish Society of Hypertension ABPM Registry investigators 9Our aim was to assess the ambulatory blood pressure monitoring (ABPM) characteristics or patterns in hypertensive patients with diabetes compared with non-diabetic hypertensives. We performed a cross-sectional analysis of a 68 045 patient database from the Spanish Society of Hypertension ABPM Registry, a nation-wide network of 41200 primary-care physicians performing ABPM under standardized conditions in daily practice. We identified 12 600 (18.5%) hypertensive patients with diabetes. When compared with patients without diabetes, diabetic hypertensives exhibited higher systolic blood pressure (BP) levels in every ABPM period (daytime 135.4 vs. 131.8, and nighttime 126.0 vs. 121.0 mm Hg, Po0.001 for both) despite they were receiving more antihypertensive drugs (mean number 1.71 vs. 1.23, Po0.001). Consequently, diabetic patients suffered from lack of control of BP more frequently than non-diabetic subjects particularly during the night (65.5% vs. 57.4%, Po0.001).Prevalence of a non-dipping BP profile (64.2% vs. 51.6%, Po0.001) was higher in diabetic patients. In the other hand, prevalence of 'white-coat' hypertension in diabetic patients was 33.0%. We conclude that there was a remarkably high prevalence of alterations in ABPM in patients with diabetes. Abnormalities in systolic BP, particularly during the night, and in circadian BP pattern could be linked with the excess of BP-related cardiovascular risk of diabetes. A wider use of ABPM in diabetic patients should be considered. Hypertension Research (2011) 34, 1185-1189; doi:10.1038/hr.2011.100; published online 11 August 2011Keywords: ambulatory blood pressure monitoring; circadian profile; diabetes; hypertension control INTRODUCTION Hypertension affects the majority of patients with diabetes and constitutes a major risk factor for vascular complications. 1 Ambulatory blood pressure monitoring (ABPM) provides a high-quality approach in estimating the true levels of blood pressure (BP). 2 Several population-and patient-based studies have showed the benefits of ABPM in exploring the relationship between BP and cardiovascular events. 2,3 A series of reports dealing with diabetic patients have also shown a close correlation between ambulatory BP and diabetic complications. 4,5 Evidences are available for the entire cardiorenal continuum of diabetic damage from the prediction of microalbuminuria by early changes in nocturnal BP in type 1 patients 6 to the effect of a riser pattern on mortality in patients with type 2 diabetes. 7 Nevertheless, information about the ABPM characteristics of large cohorts of diabetic hypertensives attending primary care centers is scarce. We aimed to assess such characteristics in comparison with non-diabetic hypertensives by using the Spanish Society of Hypertension ABPM Registry.

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“…At present, no studies on the long-term predictive value of ambulatory PP for nephropathy progression in patients with type 2 diabetes have been published. Impaired nocturnal BP decline ('non-dipping') is another BP abnormality that has been associated with micro- [1,[10][11][12][13][14][15][16][17] and macrovascular [1,18] complications in type 1 and type 2 diabetic patients. In a recently published 3 year follow-up study in elderly patients with type 2 diabetes [19], patients with a reversed diurnal BP rhythm (nocturnal BP 'risers') had an increased risk of nephropathy progression compared with those who had a normal reduction in BP during the night ('dippers').…”

Section: Introductionmentioning

confidence: 99%

Ambulatory pulse pressure, decreased nocturnal blood pressure reduction and progression of nephropathy in type 2 diabetic patients

et al. 2009

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Aims/hypothesis We followed type 2 diabetic patients over a long period to evaluate the predictive value of ambulatory pulse pressure (PP) and decreased nocturnal BP reduction (non-dipping) for nephropathy progression. Methods Type 2 diabetic patients (n=112) were followed for an average of 9.5 (range 0.5-14.5) years. At baseline, all patients underwent 24 h ambulatory BP measurement. Urinary albumin excretion rate was evaluated by three urinary albumin:creatinine ratio measurements at baseline and follow-up. Results At baseline, patients who subsequently progressed to a more advanced nephropathy stage (n=35) had reduced diastolic night/day BP variation and higher 24 h systolic BP and PP values; they also had more advanced nephropathy and were more likely to smoke than those with no progression of nephropathy (n=77). In a Cox regression analysis, independent predictors of nephropathy progression were 24 h PP (p<0.01), diastolic night:day BP ratio (p=0.02) and smoking (p=0.02). The adjusted hazards ratio (95% CI) for each mmHg increment in 24 h PP was 1.04 (1.01-1.07), whereas the adjusted hazards ratio (95% CI) for each 1% increase in diastolic night:day BP ratio was 1.06 (1.01-1.11). Only one of 33 patients (3.0%) with both a diastolic night:day BP ratio and a 24 h PP below the median progressed, whereas 17 of 32 patients (53.1%) with both a diastolic night:day BP ratio and a 24 h PP equal to or above the median progressed to a more advanced nephropathy stage (p<0.001). Conclusions/interpretation Ambulatory PP, impaired nocturnal BP decline and smoking are strong, independent predictors of nephropathy progression in type 2 diabetic patients.

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Increase in Nocturnal Blood Pressure and Progression to Microalbuminuria in Type 1 Diabetes

Abstract: In persons with type 1 diabetes, an increase in systolic blood pressure during sleep precedes the development of microalbuminuria. In those whose blood pressure during sleep decreases normally, the progression from normal albumin excretion to microalbuminuria appears to be less likely.

Cited by 655 publications

References 36 publications

Factors associated with progression to macroalbuminuria in microalbuminuric Type 1 diabetic patients: the EURODIAB Prospective Complications Study

Factors associated with progression to macroalbuminuria in microalbuminuric Type 1 diabetic patients: the EURODIAB Prospective Complications Study

Abnormalities in ambulatory blood pressure monitoring in hypertensive patients with diabetes

Ambulatory pulse pressure, decreased nocturnal blood pressure reduction and progression of nephropathy in type 2 diabetic patients

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