title: Association Between High and Very High Albuminuria and Nighttime Blood Pressure: Influence of Diabetes and Chronic Kidney Disease.
abstract: Nighttime blood pressure (BP) and albuminuria are two important and independent predictors of cardiovascular morbidity and mortality. Here, we examined the quantitative differences in nighttime systolic BP (SBP) across albuminuria levels in patients with and without diabetes and chronic kidney disease.
  
  
  
  A total of 16,546 patients from the Spanish Ambulatory Blood Pressure Monitoring Registry cohort (mean age 59.6 years, 54.9% men) were analyzed. Patients were classified according to estimated glomerular filtration rate (eGFR), as ≥60 or <60 mL/min/1.73 m(2) (low eGFR), and urine albumin-to-creatinine ratio, as normoalbuminuria (<30 mg/g), high albuminuria (30-300 mg/g), or very high albuminuria (>300 mg/g). Office and 24-h BP were determined with standardized methods and conditions.
  
  
  
  High albuminuria was associated with a statistically significant and clinically substantial higher nighttime SBP (6.8 mmHg higher than with normoalbuminuria, P < 0.001). This association was particularly striking at very high albuminuria among patients with diabetes and low eGFR (16.5 mmHg, P < 0.001). Generalized linear models showed that after full adjustment for demographic, lifestyles, and clinical characteristics, nighttime SBP was 4.8 mmHg higher in patients with high albuminuria than in those with normoalbuminuria (P < 0.001), and patients with very high albuminuria had a 6.1 mmHg greater nighttime SBP than those with high albuminuria (P < 0.001). These differences were 3.8 and 3.1 mmHg, respectively, among patients without diabetes, and 6.5 and 8 mmHg among patients with diabetes (P < 0.001).
  
  
  
  Albuminuria in hypertensive patients is accompanied by quantitatively striking higher nighttime SBP, particularly in those with diabetes with very high albuminuria and low eGFR.
authors: Hypertension Unit, Institute of Research i+12, Hospital Universitario 12 de Octubre, Madrid, Spain gemaruiz@h12o.es ruilope@ad-hocbox.com.
authors: Gema
authors: G
authors: Ruiz-Hurtado
authors: Hypertension Unit, Institute of Research i+12, Hospital Universitario 12 de Octubre, Madrid, Spain Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ and CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain gemaruiz@h12o.es ruilope@ad-hocbox.com.
authors: Luis M
authors: LM
authors: Ruilope
authors: Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Barcelona, Spain.
authors: Alex
authors: A
authors: de la Sierra
authors: Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Greece.
authors: Pantelis
authors: P
authors: Sarafidis
authors: Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ and CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain.
authors: Juan J
authors: JJ
authors: de la Cruz
authors: Department of Nephrology, Hospital Universitario Central de Asturias, RedinRen, Oviedo, Spain.
authors: Manuel
authors: M
authors: Gorostidi
authors: Hypertension Unit, Institute of Research i+12, Hospital Universitario 12 de Octubre, Madrid, Spain.
authors: Julián
authors: J
authors: Segura
authors: Centre d'Atenció Primària la Mina, University of Barcelona, Barcelona, Spain.
authors: Ernest
authors: E
authors: Vinyoles
authors: Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ and CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain.
authors: José R
authors: JR
authors: Banegas
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000150:complications / Q000503:physiopathology*; D001794:Blood Pressure / Q000502:physiology*; D002940:Circadian Rhythm; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000503:physiopathology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000503:physiopathology*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D012042:Registries; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000503:physiopathology*