Urinary Albumin Excretion Rate Is Associated With Increased Ambulatory Blood Pressure in Normoalbuminuric Type 2 Diabetic Patients

Leitão, Cristiane Bauermann; Canani, Luís Henrique Santos; Polson, Patrícia B; Molon, Marcel P.; Pinotti, Antonio Fernando Furlan; Gross, Jorge Luiz

doi:10.2337/diacare.28.7.1724

Cited by 22 publications

(16 citation statements)

References 24 publications

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“…These data were confirmed in a prospective study carried out in normoalbuminuric Type 1 DM patients, in which those patients who progressed to microalbuminuria had higher daytime levels of diastolic BP at the initial assessment 39 . Similar results were identified in a cross-section study performed in normoalbuminuric Type 2 DM patients 13 . The 24-hour BP means and the pulse pressures showed positive and significant correlations with the UAE measurement in a sample of 90 Brazilian patients 13 .…”

Section: Mean Pressure Values and Diabetes Mellitussupporting

confidence: 88%

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Monitorização ambulatorial da pressão arterial e diabete melito tipo 2

Leitão¹,

Canani²,

Silveiro³

et al. 2007

Arq. Bras. Cardiol.

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SummaryHypertension is one of the main risk factors for the onset and progression of chronic complications in type 2 diabetes mellitus (DM).Ambulatory blood pressure (BP) monitoring (ABPM) provides a better correlation with target organ lesions than BP obtained in the office. Furthermore, it allows the evaluation of distinct BP parameters such as the 24-h, daytime and nighttime systolic and diastolic BP means, BP loads and the absence of nocturnal drop of BP, as well as the identification of white-coat and masked hypertension.DM patients have higher daytime and nighttime BP means than non-DM patients. In addition, one third of normotensive type 2 DM patients have masked hypertension, which is associated with an increase in albuminuria and in left ventricle wall thickness. On the other hand, the prevalence and effect of white-coat hypertension in type 2 DM patients have not yet been properly evaluated. The absence of nocturnal drop of BP does not add information to the 24 h, daytime or nighttime BP measurements, but the nighttime BP means seem to be relevant in DM retinopathy.In conclusion, BP determination by ABPM allows better patient risk stratification for the development of DM chronic complications and is an essential instrument for effective BP control in these patients. Arterial pressure and diabetes mellitusType 2 diabetes mellitus (DM) is associated with the development of chronic microvascular and macrovascular complications with high rates of morbidity and mortality 1,2 . The classic and most analyzed risk factors for the development and progression of chronic DM complications are DM duration, hyperglycemia, arterial hypertension (AH), dyslipidemia, and smoking, besides genetic factors [3][4][5][6][7][8] . The treatment of hyperglycemia and SAH results in primary prevention and reduction of the progression of diabetic retinopathy (DR) and diabetic nephropathy (DN) 9,10

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Section: Mean Pressure Values and Diabetes Mellitussupporting

confidence: 88%

“…SAH is prevalent in patients with Type 2 DM, and is currently present in 30% of cases at the time of DM diagnosis and in up to 73% during the clinical course 1,11 . However, pressure homeostasis modifications can occur in DM patients with no evidence of renal disease 12,13 .…”

Section: Arterial Pressure and Diabetes Mellitusmentioning

confidence: 99%

Monitorização ambulatorial da pressão arterial e diabete melito tipo 2

Leitão¹,

Canani²,

Silveiro³

et al. 2007

Arq. Bras. Cardiol.

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“…Although the crosssectional design did not allow any firm conclusions regarding causality, we hypothesised that PP could be a risk factor for the progression of albuminuria in this patient group. Subsequently, several studies have associated an elevated PP with both micro- [3,5] and macrovascular [6][7][8] complications in diabetic patients.…”

Section: Discussionmentioning

confidence: 99%

“…An elevated pulse pressure (PP) is strongly associated with micro- [1][2][3][4][5] as well as macrovascular [1,[6][7][8] complications in type 2 diabetic patients. In a large observational study including 954 elderly type 2 diabetic patients [9], ambulatory PP was a strong and independent predictor of progression of nephropathy during a 2 year follow-up period.…”

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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“…Abnormalities in blood pressure homeostasis demonstrated on ambulatory blood pressure monitoring (ABPM) have a better correlation with target organ lesions than ordinary office blood pressure measurements (3,4).…”

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confidence: 99%

Impact of White-Coat Hypertension on Microvascular Complications in Type 2 Diabetes

et al. 2008

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OBJECTIVE -The purpose of this study was to determine the impact of white-coat hypertension (WCH) on microvascular complications in type 2 diabetes. RESEARCH DESIGN AND METHODS-A cross-sectional study was conducted in normotensive patients and patients with WCH selected from a cohort of 319 type 2 diabetic patients. Normotension was defined by office blood pressure Ͻ140/90 mmHg and daytime blood pressure Ͻ135/85 mmHg on ambulatory blood pressure monitoring (ABPM). WCH was defined as office blood pressure Ն140/90 mmHg and daytime blood pressure Ͻ135/85 mmHg on ABPM. Subjects were evaluated for diabetic nephropathy (24-h urinary albumin excretion rate) and diabetic retinopathy (classified according to the Global Diabetic Retinopathy Group).RESULTS -Forty-six type 2 diabetic patients had WCH (14.4%; mean age 56.6 years; 45.3% men) and 117 had normotension (36.6%; mean age 55.8 years; 37.5% men). These groups did not differ in clinical and main laboratory characteristics. Systolic ABPM (24-h: 124.7 Ϯ 6.7 vs. 121.0 Ϯ 8.5 mmHg, P ϭ 0.01 and daytime: 126.6 Ϯ 7.2 vs. 123.2 Ϯ 8.2 mmHg, P ϭ 0.01) and blood pressure loads were higher in subjects with WCH than in the normotensive subjects. WCH was associated with an increased risk for macroalbuminuria (odds ratio 4.9 [95% CI 1.3-18.7], P ϭ 0.01). On multivariate analysis models, WCH was associated with macroalbuminuria (2.0 [1.3-3.2], P ϭ 0.02) and increased the risk for both nonproliferative and proliferative diabetic retinopathy (2.7 [1.2-6.6], P ϭ 0.02 for any degree of diabetic retinopathy) after adjustments for confounding factors. CONCLUSIONS -Type 2 diabetic patients with WCH have an increased risk for diabetic retinopathy and diabetic nephropathy. Therefore, WCH should not be considered a harmless condition, and treatment should be considered.

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Urinary Albumin Excretion Rate Is Associated With Increased Ambulatory Blood Pressure in Normoalbuminuric Type 2 Diabetic Patients

Cited by 22 publications

References 24 publications

Monitorização ambulatorial da pressão arterial e diabete melito tipo 2

Monitorização ambulatorial da pressão arterial e diabete melito tipo 2

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

Impact of White-Coat Hypertension on Microvascular Complications in Type 2 Diabetes

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