title: Predisposition to essential hypertension and development of diabetic nephropathy in IDDM patients.
abstract: Conflicting results have been reported on the relationship between familial predisposition to hypertension and development of diabetic nephropathy in IDDM. In our case-control study, we assessed the prevalence of hypertension among parents of 73 IDDM patients with diabetic nephropathy (DN+; persistent albuminuria > 200 microg/min or > 300 mg/24 h) and 73 IDDM patients without diabetic nephropathy (DN-; urinary albumin excretion < 20 microg/min or < 30 mg/24 h). Arterial hypertension, defined as antihypertensive therapy or a 24-h ambulatory blood pressure (SpaceLabs 90207) > or = 135/85 mmHg, was present in 57% of parents of DN+ patients compared with 41% of parents of DN- patients (P = 0.034; difference 16% [95% CI 1.3-29.6%]). In addition, the cumulative incidence of hypertension was higher among parents of DN+ patients (log-rank test P < 0.001), with a shift toward younger age at onset of hypertension in this group. However, the difference in prevalence of parental hypertension was not evident using office blood pressure measurements (64 vs. 57%; NS; difference 7% [-5.8-20%). Furthermore, patients with DN+ and with antihypertensive therapy in both parents were themselves more frequently treated for hypertension than were patients with DN+ and without parental treatment for hypertension (100 vs. 61%; P = 0.034; difference 39% [21-57%]). In conclusion, familial predisposition to essential hypertension increases the risk of diabetic nephropathy and may also contribute to the development of systemic hypertension in patients with IDDM and diabetic nephropathy.
authors.affiliation: Department of Medicine, Helsinki University Central Hospital, Finland.
authors.forename: J A
authors.initials: JA
authors.lastname: Fagerudd
authors.forename: L
authors.initials: L
authors.lastname: Tarnow
authors.forename: P
authors.initials: P
authors.lastname: Jacobsen
authors.forename: S
authors.initials: S
authors.lastname: Stenman
authors.forename: F S
authors.initials: FS
authors.lastname: Nielsen
authors.forename: K J
authors.initials: KJ
authors.lastname: Pettersson-Fernholm
authors.forename: C
authors.initials: C
authors.lastname: Grönhagen-Riska
authors.forename: H H
authors.initials: HH
authors.lastname: Parving
authors.forename: P H
authors.initials: PH
authors.lastname: Groop
mesh_terms: D000328:Adult; D000367:Age Factors; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D016022:Case-Control Studies; D002940:Circadian Rhythm; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000503:physiopathology; D003925:Diabetic Angiopathies / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology; D003928:Diabetic Nephropathies / Q000150:complications / Q000453:epidemiology / Q000235:genetics*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology; D015994:Incidence; D008297:Male; D010290:Parents