Nephrology Dialysis Transplantation, Vol 13, Issue 3 635-639, Copyright © 1998 by Oxford University Press
C Farmer, D Goldsmith, D Quin, P Dallyn, J Cox, J Kingswood and P Sharpstone
Background: Hypertensive non-diabetic patients who
lack the normal nocturnal decline in blood pressure ('non-dippers') have an
increased incidence of cardiovascular complications. Poor blood pressure
control is known to exacerbate the decline in glomerular filtration rate in
patients with diabetic nephropathy. Methods: The aim
of this study was to assess the contribution of abnormal blood pressure
diurnal rhythm to the progression of diabetic nephropathy. We
retrospectively studied 26 diabetic patients with hypertension proteinuria
and relentless progressive impairment of renal function due to diabetic
nephropathy between 1990 and 1996. Patients underwent ambulatory blood
pressure monitoring and were classified as either 'dippers' or
'non-dippers' according to their blood pressure diurnal rhythm. Dippers
were patients whose mean sleeping blood pressure (both systolic and
diastolic) was 10% less than blood pressure whilst awake. Weight, glycated
haemoglobin, serum creatinine (&mgr;mol/l) and blood pressure (mmHg)
were recorded on a 3-monthly basis. Twenty four hour urine protein
excretion and creatinine clearance were recorded annually. The rate of
decline of creatinine clearance was derived from serum creatinine
estimation. Results: In the 'dipper' group, the rate
of decline of creatinine clearance was -2.9 ml/min/year and in those with
abnormal blood pressure diurnal rhythm it was -7.9 ml/min/year
(P<0.05). There was no significant difference in day-time mean blood
pressures, glycated haemoglobin, age and numbers with insulin-dependent
diabetes mellitus. Conclusion: We found that there was
a profound effect of non-dipping upon the rate of decline of renal function
in patients with diabetic nephropathy. Key words:
ambulatory blood pressure; creatinine clearance; diabetic nephropathy;
diurnal rhythm
ORIGINAL ARTICLES
Progression of diabetic nephropathy-is diurnal blood pressure rhythm as important as absolute blood pressure level?
Trafford Department of Renal Medicine, Royal Sussex County Hospital, Eastern Road, Brighton BN2 5BE, UK; Corresponding author
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