Ambulatory blood pressure measurements are related to albumin excretion and are predictive for risk of microalbuminuria in young people with type 1 diabetes

• Published in: Diabetologia Vol. 52; no. 6; pp. 1173 - 1181
• Main Authors: Marcovecchio, M. L, Dalton, R. N, Schwarze, C. P, Prevost, A. T, Neil, H. A. W, Acerini, C. L, Barrett, T, Cooper, J. D, Edge, J, Shield, J, Widmer, B, Todd, J. A, Dunger, D. B
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Berlin/Heidelberg : Springer-Verlag 01.06.2009; Springer-Verlag; Springer; Springer Nature B.V
• Subjects: Albumin excretion; Albumins - secretion; Albuminuria - etiology; Albuminuria - physiopathology; Ambulatory blood pressure monitoring; Associated diseases and complications; Biological and medical sciences; Blood pressure; Blood Pressure - physiology; Creatinine; Diabetes; Diabetes Mellitus, Type 1 - pathology; Diabetes Mellitus, Type 1 - physiopathology; Diabetes Mellitus, Type 1 - urine; Diabetes. Impaired glucose tolerance; Diabetic nephropathy; Endocrine pancreas. Apud cells (diseases); Endocrinology; Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Hospitals; Human Physiology; Humans; Hypotheses; insulin-dependent diabetes mellitus; Internal Medicine; Kidneys; Male; Medical sciences; Medicine; Medicine & Public Health; Metabolic Diseases; Microalbuminuria; Nephrology. Urinary tract diseases; Pediatrics; Proportional Hazards Models; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; Young people; United Kingdom > UK; Young people; Type 1 diabetes; Diabetic nephropathy; Blood pressure; Microalbuminuria; Albumin excretion; Ambulatory blood pressure monitoring; Endocrinopathy; Kidney disease; Immunopathology; Excretion; Urinary system disease; Type 1 diabetes; Young people; Albumin; Albumin excretion; Ambulatory blood pressure monitoring; Blood pressure; Diabetic nephropathy; Autoimmune disease; Concomitant disease; Risk factor; Hemodynamics; Proteinuria
• ISSN: 0012-186X; 1432-0428
• DOI: 10.1007/s00125-009-1327-6

Aims/hypothesis 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 HbA₁c. 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 log₁₀ 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 HbA₁c, 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/interpretation 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.