title: Effects of multiple factorial intervention on ambulatory BP profile and renal function in hypertensive type 2 diabetic patients with overt nephropathy - a pilot study.
abstract: Accumulating evidence has shown that diabetic patients are increasing in number, and renal and cardiovascular complications are the most common cause of death in diabetic patients. Thus, it would be of considerable value to identify the mechanisms involved in the progression of renal impairment and cardiovascular injury associated with diabetes. Recent evidence also indicated that multifactorial intervention is able to reduce the risk of cardiovascular disease and death among patients with diabetes and microalbuninuria. In this pilot study, we examined the effects of intensified multifactorial intervention, with tight glucose regulation and the use of valsartan and fluvastatin on ambulatory blood pressure (BP) profile, estimated glomerular filtration rate (eGFR), and urinary albumin to creatinine ratio (UACR), in 20 hypertensive patients (16 male and 4 female) with type 2 diabetes mellitus and overt nephropathy. After 12 months of intensified treatment, office BP, fasting plasma glucose (FPG), and low-density lipoprotein cholesterol (LDLC) were significantly decreased compared to baseline (systolic blood pressure (SBP), 130 ± 2 vs. 150 ± 1 mmHg; diastolic blood pressure (DBP), 76 ± 1 vs. 86 ± 1 mmHg; FPG, 117 ± 5 vs. 153 ± 7 mg/dl; LDLC, 116 ± 8 vs. 162 ± 5 mg/dl, P < 0.0001). Also, compared to the baseline values, the daytime and nighttime ambulatory BP and short-term BP variability were significantly decreased after 12 months. Furthermore, while eGFR was not altered (44.3 ± 5.1 vs. 44.3 ± 6.5 ml/min/1.73 m(2), not significant (NS)), UACR showed a significant reduction after 12 months of intensified treatment (1228 ± 355 vs. 2340 ± 381 mg/g-cr, P < 0.05). These results suggest that the intensified multifactorial intervention is able to improve ambulatory BP profile, preserve renal function, and reduce urinary albumin excretion in type 2 diabetic hypertensive patients with overt nephropathy.
authors.affiliation: Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Kanaoka
authors.forename: Kouichi
authors.initials: K
authors.lastname: Tamura
authors.forename: Tatsumi
authors.initials: T
authors.lastname: Moriya
authors.forename: Keiji
authors.initials: K
authors.lastname: Tanaka
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Konno
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kondoh
authors.forename: Masao
authors.initials: M
authors.lastname: Toyoda
authors.forename: Tomoya
authors.initials: T
authors.lastname: Umezono
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Fujikawa
authors.forename: Masato
authors.initials: M
authors.lastname: Ohsawa
authors.forename: Toru
authors.initials: T
authors.lastname: Dejima
authors.forename: Akinobu
authors.initials: A
authors.lastname: Maeda
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Wakui
authors.forename: Sona
authors.initials: S
authors.lastname: Haku
authors.forename: Mai
authors.initials: M
authors.lastname: Yanagi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Mitsuhashi
authors.forename: Motoko
authors.initials: M
authors.lastname: Ozawa
authors.forename: Yasuko
authors.initials: Y
authors.lastname: Okano
authors.forename: Nariaki
authors.initials: N
authors.lastname: Ogawa
authors.forename: Tadashi
authors.initials: T
authors.lastname: Yamakawa
authors.forename: Shunsaku
authors.initials: S
authors.lastname: Mizushima
authors.forename: Daisuke
authors.initials: D
authors.lastname: Suzuki
authors.forename: Satoshi
authors.initials: S
authors.lastname: Umemura
mesh_terms: D000419:Albuminuria / Q000652:urine; D000924:Anticholesteremic Agents / Q000494:pharmacology; D000959:Antihypertensive Agents / Q000494:pharmacology; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D002940:Circadian Rhythm / Q000502:physiology*; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology*; D003928:Diabetic Nephropathies / Q000209:etiology / Q000503:physiopathology*; D005229:Fatty Acids, Monounsaturated / Q000494:pharmacology; D005260:Female; D000077340:Fluvastatin; D005919:Glomerular Filtration Rate / Q000187:drug effects / Q000502:physiology; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology*; D007211:Indoles / Q000494:pharmacology; D007668:Kidney / Q000503:physiopathology*; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D012044:Regression Analysis; D013777:Tetrazoles / Q000494:pharmacology; D014633:Valine / Q000031:analogs & derivatives / Q000494:pharmacology; D000068756:Valsartan
chemical_list: D000924:Anticholesteremic Agents; D000959:Antihypertensive Agents; D001786:Blood Glucose; D005229:Fatty Acids, Monounsaturated; D007211:Indoles; D008055:Lipids; D013777:Tetrazoles; D000077340:Fluvastatin; D000068756:Valsartan; D014633:Valine