title: Ambulatory blood pressure measurements are related to albumin excretion and are predictive for risk of microalbuminuria in young people with type 1 diabetes.
abstract: OBJECTIVE
  The relationship between BP and microalbuminuria in young people with type 1 diabetes is not completely clear. As microalbuminuria is preceded by a gradual rise in albumin excretion within the normal range, we hypothesised that ambulatory BP (ABP) may be closely related to albumin excretion and progression to microalbuminuria.
  
  
  METHODS
  ABP monitoring (ABPM) was performed in 509 young people with type 1 diabetes (age median [range]: 15.7 [10.7-22.6] years) followed with annual assessments of three early morning urinary albumin:creatinine ratios (ACRs) and HbA(1c). Systolic BP (SBP) and diastolic BP (DBP) and the nocturnal fall in BP were analysed in relation to ACR.
  
  
  RESULTS
  All ABPM variables were significantly related to baseline log(10) ACR (p < 0.001). After the ABPM evaluation, 287 patients were followed for a median of 2.2 (1.0-5.5) years. ABP at baseline was independently related to mean ACR during follow-up. Nineteen initially normoalbuminuric patients developed microalbuminuria after 2.0 (0.2-4.0) years and their baseline daytime DBP was higher than in normoalbuminuric patients (p < 0.001). After adjusting for baseline ACR and HbA(1c), there was an 11% increased risk of microalbuminuria for each 1 mmHg increase in daytime DBP. Forty-eight per cent of patients were non-dippers for SBP and 60% for DBP; however, ACR was not different between dippers and non-dippers and there were no differences in the nocturnal fall in BP between normoalbuminuric and future microalbuminuric patients.
  
  
  CONCLUSIONS
  In this cohort of young people with type 1 diabetes, ABP was significantly related to ACR, and daytime DBP was independently associated with progression to microalbuminuria. Increasing albumin excretion, even in the normal range, may be associated with parallel rises in BP.
authors.affiliation: Department of Paediatrics, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.
authors.forename: M L
authors.initials: ML
authors.lastname: Marcovecchio
authors.forename: R N
authors.initials: RN
authors.lastname: Dalton
authors.forename: C P
authors.initials: CP
authors.lastname: Schwarze
authors.forename: A T
authors.initials: AT
authors.lastname: Prevost
authors.forename: H A W
authors.initials: HA
authors.lastname: Neil
authors.forename: C L
authors.initials: CL
authors.lastname: Acerini
authors.forename: T
authors.initials: T
authors.lastname: Barrett
authors.forename: J D
authors.initials: JD
authors.lastname: Cooper
authors.forename: J
authors.initials: J
authors.lastname: Edge
authors.forename: J
authors.initials: J
authors.lastname: Shield
authors.forename: B
authors.initials: B
authors.lastname: Widmer
authors.forename: J A
authors.initials: JA
authors.lastname: Todd
authors.forename: D B
authors.initials: DB
authors.lastname: Dunger
mesh_terms: D000418:Albumins / Q000378:metabolism*; D000419:Albuminuria / Q000209:etiology* / Q000503:physiopathology*; D001794:Blood Pressure / Q000502:physiology*; D003922:Diabetes Mellitus, Type 1 / Q000473:pathology / Q000503:physiopathology* / Q000652:urine; D005260:Female; D006801:Humans; D008297:Male; D016016:Proportional Hazards Models
chemical_list: D000418:Albumins