title: Morning pulse pressure is associated more strongly with elevated albuminuria than systolic blood pressure in patients with type 2 diabetes mellitus: post hoc analysis of a cross-sectional multicenter study.
abstract: OBJECTIVE
  Recently, focus has been directed toward pulse pressure as a potentially independent risk factor for micro- and macrovascular disease. This study was designed to examine the relationship between pulse pressure taken at home and elevated albuminuria in patients with type 2 diabetes.
  
  
  METHODS
  This study is a post hoc analysis of a cross-sectional multicenter study. Home blood pressure measurements were performed for 14 consecutive days in 858 patients with type 2 diabetes. We investigated the relationship between systolic blood pressure or pulse pressure in the morning or in the evening and urinary albumin excretion using univariate and multivariate analyses. Furthermore, we measured area under the receiver-operating characteristic curve (AUC) to compare the ability to identify elevated albuminuria, defined as urinary albumin excretion equal to or more than 30 mg/g creatinine, of systolic blood pressure or pulse pressure.
  
  
  RESULTS
  Morning systolic blood pressure (β=0.339, P<0.001) and morning pulse pressure (β=0.378, P<0.001) were significantly associated with logarithm of urinary albumin excretion independent of other potential co-factors. AUC for elevated albuminuria in morning systolic blood pressure and morning pulse pressure were 0.668 (0.632-0.705; P<0.001) and 0.694 (0.659-0.730; P<0.001), respectively. AUC of morning pulse pressure was significantly greater than that of morning systolic blood pressure (P=0.040).
  
  
  CONCLUSIONS
  Our findings implicate that morning pulse pressure is associated with elevated albuminuria in patients with type 2 diabetes, which suggests that lowering morning pulse pressure could prevent the development and progression of diabetic nephropathy.
authors.affiliation: Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
authors.forename: Emi
authors.initials: E
authors.lastname: Ushigome
authors.forename: Michiaki
authors.initials: M
authors.lastname: Fukui
authors.forename: Masahide
authors.initials: M
authors.lastname: Hamaguchi
authors.forename: Shinobu
authors.initials: S
authors.lastname: Matsumoto
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Mineoka
authors.forename: Naoko
authors.initials: N
authors.lastname: Nakanishi
authors.forename: Takafumi
authors.initials: T
authors.lastname: Senmaru
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yamazaki
authors.forename: Goji
authors.initials: G
authors.lastname: Hasegawa
authors.forename: Naoto
authors.initials: N
authors.lastname: Nakamura
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000419:Albuminuria / Q000503:physiopathology*; D001161:Arteriosclerosis / Q000503:physiopathology; D001794:Blood Pressure / Q000502:physiology*; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D003928:Diabetic Nephropathies / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult
keywords: Arteriosclerosis; Diabetic nephropathy; Home blood pressure monitoring