Higher Nocturnal Blood Pressure Predictive Of Kidney Disease In Diabetes

[Guest guest]

Source:   Northwestern University (http://www.nwu.edu/)

Date:   Posted 9/12/2002

Higher Nocturnal Blood Pressure Predictive Of Kidney Disease In Diabetes

Monitoring nighttime blood pressure is a simple, painless and noninvasive

method of identifying patients with type 1 diabetes who are at increased

risk for kidney disease, according to a study published in the Sept. 12

issue of The New England Journal of Medicine.

Batlle, M.D., professor of medicine at The Feinberg School of

Medicine at Northwestern University and researchers from Spain showed that

in persons with type 1 diabetes, an increase in systolic blood pressure

during sleep precedes the development of microalbuminuria -- or a protein

called albumin in the urine -- a condition that is predictive of kidney

disease.

In their prospective study, the investigators used 24-hour ambulatory blood

pressure monitoring in 75 adolescents and young adults with type 1 diabetes

who had normal blood pressure and urinary albumin excretion levels at

enrollment. Over a follow-up period of five years, 14 of the patients had

developed microalbuminuria.

This group also had nighttime systolic blood pressure that was significantly

higher than those in study participants with normal urinary albumin levels.

By contrast, in those whose blood pressure during sleep decreased normally,

the progression from normal albumin excretion to microalbuminuria appeared

to be less likely.

Blood pressure has a normal circadian rhythm and varies depending on levels

of stress and physical activity.

" Thus, blood pressure measured randomly at the physician's office cannot

fully reflect blood pressure levels around the clock, particularly when it

is close to the normal range at earlier stages of diabetes, " Batlle said.

The researchers said that an increase in nighttime systolic pressure appears

to be the earliest detectable manifestation of altered blood pressure

regulation in patients with type 1 diabetes and may provide a good way for

choosing or avoiding unnecessary therapies to prevent microalbuminuria and

kidney disease in patients with type 1 diabetes.