title: Awaking Blood Pressure Surge and Progression to Microalbuminuria in Type 2 Normotensive Diabetic Patients.
abstract: BACKGROUND
  We investigated the predictive value of morning blood pressure surge (MBPS) on the development of microalbuminuria in normotensive adults with a recent diagnosis of type 2 diabetes.
  
  
  METHODS
  Prospective assessments of 24-hour ambulatory blood pressure monitoring and urinary albumin excretion were performed in 377 adult patients. Multivariate-adjusted Cox regression models were used to assess hazard ratios (HRs) between baseline and changes over follow-up in MBPS and the risk of microalbuminuria. The MBPS was calculated as follows: mean systolic BP during the 2 hours after awakening minus mean systolic BP during the 1 hour that included the lowest sleep BP.
  
  
  RESULTS
  After a mean follow-up of 6.5 years, microalbuminuria developed in 102 patients. An increase in MBPB during follow-up was associated with an increased risk of microalbuminuria. Compared to individuals in the lowest tertile (-0.67 ± 1.10 mmHg), the HR and 95% CI for microalbuminuria in those in the highest tertile of change (24.86 ± 6.92 mmHg) during follow-up were 17.41 (95% CI 6.26-48.42); p for trend <0.001. Mean SD MBPS significantly increased in those who developed microalbuminuria from a mean [SD] of 10.6 [1.4] to 36.8 [7.1], p < 0.001.
  
  
  CONCLUSIONS
  An increase in MBPS is associated with the risk of microalbuminuria in normotensive adult patients with type 2 diabetes.
authors.affiliation: Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, Piazza Miraglia 2, 80138 Naples, Italy.
authors.forename: Michelangela
authors.initials: M
authors.lastname: Barbieri
authors.affiliation: Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, Piazza Miraglia 2, 80138 Naples, Italy.
authors.forename: Maria Rosaria
authors.initials: MR
authors.lastname: Rizzo
authors.affiliation: Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, Piazza Miraglia 2, 80138 Naples, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Fava
authors.affiliation: Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, Piazza Miraglia 2, 80138 Naples, Italy.
authors.forename: Celestino
authors.initials: C
authors.lastname: Sardu
authors.affiliation: Evangelical Hospital Villa Betania, Naples, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Angelico
authors.affiliation: Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, Piazza Miraglia 2, 80138 Naples, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Paolisso
authors.affiliation: Alzheimer's Disease Clinic, ASL Frosinone, Atina, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: Abbatecola
authors.affiliation: Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, Piazza Miraglia 2, 80138 Naples, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Paolisso
authors.affiliation: Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, Piazza Miraglia 2, 80138 Naples, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Marfella
mesh_terms: D000328:Adult; D000419:Albuminuria / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D016009:Chi-Square Distribution; D002940:Circadian Rhythm; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D003928:Diabetic Nephropathies / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014851:Wakefulness
references.citation: N Engl J Med. 2001 Sep 20;345(12):870-8
references.pmid: 11565519
references.citation: Hypertension. 2001 Apr;37(4):1053-9
references.pmid: 11304502
references.citation: Kidney Int. 2003 Jan;63(1):225-32
references.pmid: 12472787
references.citation: N Engl J Med. 2003 Jan 16;348(3):260-4; author reply 260-4
references.pmid: 12530443
references.citation: Hypertension. 2003 Feb;41(2):237-43
references.pmid: 12574088
references.citation: Circulation. 2003 Mar 18;107(10):1401-6
references.pmid: 12642361
references.citation: J Am Coll Cardiol. 2003 May 21;41(10):1753-8
references.pmid: 12767660
references.citation: J Hypertens. 2004 Feb;22(2):349-55
references.pmid: 15076193
references.citation: Am J Epidemiol. 1994 Jul 15;140(2):123-31
references.pmid: 8023801
references.citation: N Engl J Med. 1999 Oct 7;341(15):1127-33
references.pmid: 10511612
references.citation: Arq Bras Endocrinol Metabol. 2006 Oct;50(5):862-8
references.pmid: 17160209
references.citation: Diabet Med. 2007 Aug;24(8):911-5
references.pmid: 17559428
references.citation: Diabetes Care. 2008 Feb;31 Suppl 2:S194-201
references.pmid: 18227485
references.citation: Ann Intern Med. 2009 Jul 7;151(1):11-20, W3-4
references.pmid: 19451554
references.citation: Clin J Am Soc Nephrol. 2012 Mar;7(3):401-8
references.pmid: 22282481
references.citation: Arch Intern Med. 2012 May 28;172(10):761-9
references.pmid: 22636820
references.citation: Chin Med J (Engl). 2013 Feb;126(3):510-4
references.pmid: 23422116
references.citation: Diabetes Res Clin Pract. 2013 Sep;101(3):270-7
references.pmid: 23871575
references.citation: Ann Intern Med. 2001 Mar 6;134(5):370-9
references.pmid: 11242497
references.citation: N Engl J Med. 2002 Sep 12;347(11):797-805
references.pmid: 12226150