[The diurnal blood pressure and the EchoCG parameters of the left ventricle in patients with diabetic nephropathy].
The purpose of the study was to examine the geometry of the left ventricle (LV) in patients with type 1 diabetes mellitus (DM) in relation to the 24-hour profile of blood pressure (BP) and urinary albumin excretion. The study covered 60 patients with type 1 DM and normal creatinine clearance, including 20 patients with normal albuminuria, 23 with microalbuminuria, and 17 with proteinuria. 24-hour BP monitoring was performed oscillometrically; myocardial structural parameters were studied by echoCG. LV hypertrophy (LVH) was found in 1 patient with normal albuminuria and in 8 with proteinuria (5, 30.4, and 47%, respectively; chi2 = 9.3; p = 0.09). The frequency of concentric and eccentric types of LVH was equal. In patients with a lower nocturnal BP decrease, the LV myocardial mass index (LVMMI) and relative posterior wall thickness (RPWT) were higher than those in other patients (LVMMI, 120.8 +/- 24.6 and 95.0 +/- 23.1 g/m2, respectively; p < 0.001; RPWT, 0.35 +/- 0.06 and 0.31 +/- 0.06, respectively, p = 0.013). Multifactorial stepwise regression analysis has indicated that age, male sex, and proneinuria directly affected LVMMI (R2 = 0.70; p < 0.001). Diastolic BP, autonomic neuropathy, and hemoglobin levels were found to be independent predictors of RPWT (R2 = 0.70; p < 0.009). The findings suggest that there is a close relationship between diabetic neuropathy and LV remodeling in patients with type 1 DM. This relationship may be operative via factors, such as arterial hypertension, altered diurnal BP profile, autonomic neuropathy, and anemia.
Bondar'
I A
IA
Klimontov
V V
VV
Koroleva
E A
EA
Zheltova
L I
LI
Chudinova
O G
OG
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001794:Blood Pressure; D015924:Blood Pressure Monitors; D002940:Circadian Rhythm; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D003928:Diabetic Nephropathies / Q000175:diagnosis*; D004452:Echocardiography; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012737:Sex Factors; D020257:Ventricular Remodeling