title: Ambulatory pulse pressure and progression of urinary albumin excretion in older patients with type 2 diabetes mellitus.
abstract: We studied whether ambulatory blood pressure monitoring added to office blood pressure in predicting progression of urine albumin excretion over 2 years of follow-up in a multiethnic cohort of older people with type-2 diabetes mellitus. Participants in the Informatics for Diabetes Education and Telemedicine study underwent a baseline evaluation that included office and 24-hour ambulatory blood pressure measurement and a spot urine measurement of albumin-to-creatinine ratio (ACR). Measurements of albumin-to-creatinine ratio were repeated 1 and 2 years later. In bivariate analyses, ambulatory 24-hour pulse pressure was the blood pressure variable most strongly associated with follow-up ACR. Repeated-measures mixed linear models (n = 1040) were built adjusting for baseline ACR ratio, clustered randomization, time to follow-up, and multiple covariates. When both were entered into the model, ambulatory 24-hour pulse pressure and office pulse pressure were independently associated with follow-up ACR (beta [SE] = 0.010 [0.002], P < 0.001, and 0.004 [0.001], P = 0.002, respectively). Cox proportional hazards models examined associations with progression of albuminuria in 954 participants without macroalbuminuria at baseline, adjusting for all of the covariates independently associated with follow-up ACR in mixed linear models. Ambulatory 24-hour pulse pressure, but not office pulse pressure, was independently associated with progression of albuminuria (P = 0.015 and 0.052, respectively). The adjusted hazards ratio (95% CI) per each 10-mm Hg increment in ambulatory pulse pressure was 1.23 (1.04 to 1.42). In conclusion, ambulatory pulse pressure may provide additional information to predict progression of albuminuria in elderly diabetic subjects above and beyond office blood pressure.
authors.affiliation: Division of General Medicine, Columbia University, New York, NY, USA. wp56@columbia.edu
authors.forename: Walter
authors.initials: W
authors.lastname: Palmas
authors.forename: Andrew
authors.initials: A
authors.lastname: Moran
authors.forename: Thomas
authors.initials: T
authors.lastname: Pickering
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Eimicke
authors.forename: Jeanne
authors.initials: J
authors.lastname: Teresi
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Schwartz
authors.forename: Lesley
authors.initials: L
authors.lastname: Field
authors.forename: Ruth S
authors.initials: RS
authors.lastname: Weinstock
authors.forename: Steven
authors.initials: S
authors.lastname: Shea
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000150:complications / Q000453:epidemiology / Q000652:urine*; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D015331:Cohort Studies; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000503:physiopathology* / Q000652:urine; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016014:Linear Models; D008297:Male; D008507:Medically Underserved Area; D015999:Multivariate Analysis; D009518:New York / Q000453:epidemiology; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models