title: Diurnal blood pressure pattern may predict the increase of urinary albumin excretion in normotensive normoalbuminuric type 1 diabetes mellitus patients.
abstract: To characterise the relationship between diurnal blood pressure and the subsequent increase of urinary albumin excretion (UAE) in normotensive normoalbuminuric type 1 diabetic patients, ambulatory blood pressure monitoring (ABPM) was performed in 53 patients, who were then followed for 5 years. Albumin excretion rate changed from 12.4 (8.9-17.2) to 29.3 (15.2-47.0) mg/day. Macroalbuminuria developed in 2 (3.8%), microalbuminuria in 22 (41.5%) patients, 29 (54.7%) remained normoalbuminuric. Night-time diastolic blood pressure was significantly higher (64.3+/-6.5 vs. 60.9+/-5.5 mmHg, P<0.05), diastolic diurnal index significantly lower (15.5+/-9.7 vs. 22.3+/-6.2%, P<0.01) in patients who later progressed to micro- or macroalbuminuria. Diastolic diurnal index (r=-0.40; P<0.01) and nocturnal diastolic pressure (r=0.35; P<0.01) were correlated to the change in albumin excretion. In a multivariate analysis model with the change of albumin excretion as dependent, and means and diurnal indices of systolic and diastolic blood pressure, baseline UAE, cholesterol, triglycerides, HbA1c and retinopathy as independent parameters (r=0.68; P=0.001), diurnal index for diastolic blood pressure (beta=-0.30; r=0.013), baseline HbA1c (beta=0.32; P=0.010) and retinopathy (beta=0.44; P=0.001) were significant independent correlates. We conclude that the relative increase of nocturnal blood pressure is associated with the subsequent increase of albuminuria, which in turn is predictive of overt diabetic nephropathy.
authors: II Department of Medicine of Szent István Hospital, Semmelweis University, Budapest, Hungary.
authors: Zoltán
authors: Z
authors: Lengyel
authors: László
authors: L
authors: Rosivall
authors: Csilla
authors: C
authors: Németh
authors: Lajos K
authors: LK
authors: Tóth
authors: Viktor
authors: V
authors: Nagy
authors: Mária
authors: M
authors: Mihály
authors: László
authors: L
authors: Kammerer
authors: Péter
authors: P
authors: Vörös
mesh_terms: D000328:Adult; D017668:Age of Onset; D000419:Albuminuria / Q000652:urine*; D001794:Blood Pressure / Q000502:physiology*; D015992:Body Mass Index; D002940:Circadian Rhythm / Q000502:physiology*; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology* / Q000652:urine; D003928:Diabetic Nephropathies / Q000097:blood / Q000503:physiopathology; D003930:Diabetic Retinopathy / Q000453:epidemiology; D018450:Disease Progression; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D012016:Reference Values; D012044:Regression Analysis
chemical_list: D006442:Glycated Hemoglobin