Nephrology Dialysis Transplantation, Vol 13, Issue 9 2257-2260, Copyright © 1998 by Oxford University Press
P Voros, Z Lengyel, V Nagy, C Nemeth, L Rosivall and L Kammerer
Background: Abnormalities of the systemic blood
pressure are closely associated with the development of diabetic
nephropathy. Our aim was to examine the relationship between diurnal blood
pressure pattern and albuminuria in insulin-dependent normotensive diabetic
patients before the development of overt nephropathy.
Methods: Urinary albumin excretion rates were
determined by radioimmunoassay, and 34-h ambulatory blood pressure
monitoring was performed. Means and diurnal index was calculated for
systolic, diastolic and mean arterial blood pressure, for day-time,
night-time, and the whole day. The results of the normoalbuminuric (n=39)
and microalbuminuric (n=29) groups are compared, and correlation of the
blood pressure parameters with albuminuria is analysed.
Results: Twenty-four hours and night-time mean blood
pressures were significantly higher, diurnal indices characterizing the
night-time blood pressure drop were smaller in the microalbuminuric group.
With multiple regression analysis a significant positive correlation was
found between albumin excretion rates and 34-h mean systolic blood pressure
and a significant negative correlation between albumin excretion rates and
the diurnal index of mean arterial pressure
(r2=0.40, P<0.0001). In the normoalbuminuric
group 1 (2.6%) patient, in the microalbuminuric group 7 (24.1%) were
'non-dippers'. Conclusion: We conclude that in
normotensive insulin-dependent diabetic patients the night-time decrease of
blood pressure is smaller if microalbuminuria is present. Higher nocturnal
blood pressure load is associated with the increase of albuminuria, even
before the onset of overt diabetic nephropathy or hypertension.
Key words: diabetes mellitus; diabetic nephropathy;
microalbuminuria; blood pressure; circadian variation; blood pressure load
ORIGINAL ARTICLES
Diurnal blood pressure variation and albuminuria in normotensive patients with insulin-dependent diabetes mellitus
2nd Department of Medicine, Szent István Kórház, II. Belgyógyászat, Budapest, 1096, Nagyvárad tér 1, Hungary; 2nd Department of Medicine, and Department of Pathophysiology, Nephrology Research and Training Centre, Semmelweis Medical University, Budapest; Corresponding author
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