Urinary albumin excretion rate is associated with increased ambulatory blood pressure in normoalbuminuric type 2 diabetic patients.
OBJECTIVE
To evaluate the 24-h blood pressure profile in normoalbuminuric type 2 diabetic patients.


METHODS
A cross-sectional study was conducted in 90 type 2 diabetic patients with a urinary albumin excretion rate (UAER) <20 microg/min on two occasions, 6 months apart (immunoturbidimetry). Patients underwent clinical and laboratory evaluations. Ambulatory blood pressure monitoring and echocardiograms were also performed.


RESULTS
UAER was found to correlate positively with systolic doctor's office blood pressure measurements (r = 0.243, P = 0.021) and ambulatory blood pressure (24 h: r = 0.280, P = 0.008) and left ventricular posterior wall thickness (r = 0.359, P = 0.010). Patients were divided into four groups according to UAER (<5, > or =5-10, > or =10-15, and > or =15-20 microg/min). Systolic blood pressure parameters for the 1st, 2nd, 3rd, and 4th groups, respectively, were 123.0 +/- 10.6, 132.5 +/- 15.0, 139.0 +/- 23.4, and 130.7 +/- 8.0 mmHg for 24-h blood pressure (ANOVA P = 0.004) and 48.4 +/- 6.0, 54.5 +/- 11.2, 58.8 +/- 15.6, and 57.6 +/- 8.0 mmHg for 24-h pulse pressure (ANOVA P = 0.003). A progressive increase in the prevalence of diabetic retinopathy was observed from the 1st to the 4th UAER group: 27.3, 43.8, 45.5, and 66.7% (P = 0.029 for trend).


CONCLUSIONS
In type 2 diabetic patients, UAER in the normoalbuminuric range is positively associated with systolic ambulatory blood pressure indexes, left ventricular posterior wall thickness, and diabetic retinopathy, suggesting that intensive blood pressure treatment may prevent diabetes complications in these patients.
Leitão
Cristiane B
CB
Endocrine division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, 90035-003 Porto Alegre, RS, Brazil. jorgegross@terra.com.br
Canani
Luís H
LH
Polson
Patrícia B
PB
Molon
Marcel P
MP
Pinotti
Antônio F
AF
Gross
Jorge L
JL
D000419:Albuminuria / Q000652:urine*; D000704:Analysis of Variance; D001794:Blood Pressure / Q000502:physiology*; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology* / Q000652:urine; D004452:Echocardiography; D005260:Female; D006801:Humans; D006973:Hypertension / Q000652:urine*; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012307:Risk Factors; D012907:Smoking