Ambulatory pulse pressure, decreased nocturnal blood pressure reduction and progression of nephropathy in type 2 diabetic patients |
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Authors: | S T Knudsen E Laugesen K W Hansen T Bek C E Mogensen P L Poulsen |
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Institution: | 1.Medical Department M (Diabetes and Endocrinology),Aarhus University Hospital,Aarhus C,Denmark;2.Department of Internal Medicine,Regional Hospital Silkeborg,Silkeborg,Denmark;3.Department of Ophthalmology,Aarhus University Hospital,Aarhus,Denmark |
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Abstract: | Aims/hypothesis We followed type 2 diabetic patients over a long period to evaluate the predictive value of ambulatory pulse pressure (PP)
and decreased nocturnal BP reduction (non-dipping) for nephropathy progression.
Methods Type 2 diabetic patients (n = 112) were followed for an average of 9.5 (range 0.5–14.5) years. At baseline, all patients underwent 24 h ambulatory BP
measurement. Urinary albumin excretion rate was evaluated by three urinary albumin:creatinine ratio measurements at baseline
and follow-up.
Results At baseline, patients who subsequently progressed to a more advanced nephropathy stage (n = 35) had reduced diastolic night/day BP variation and higher 24 h systolic BP and PP values; they also had more advanced
nephropathy and were more likely to smoke than those with no progression of nephropathy (n = 77). In a Cox regression analysis, independent predictors of nephropathy progression were 24 h PP (p < 0.01), diastolic night:day BP ratio (p = 0.02) and smoking (p = 0.02). The adjusted hazards ratio (95% CI) for each mmHg increment in 24 h PP was 1.04 (1.01–1.07), whereas the adjusted
hazards ratio (95% CI) for each 1% increase in diastolic night:day BP ratio was 1.06 (1.01–1.11). Only one of 33 patients
(3.0%) with both a diastolic night:day BP ratio and a 24 h PP below the median progressed, whereas 17 of 32 patients (53.1%)
with both a diastolic night:day BP ratio and a 24 h PP equal to or above the median progressed to a more advanced nephropathy
stage (p < 0.001).
Conclusions/interpretation Ambulatory PP, impaired nocturnal BP decline and smoking are strong, independent predictors of nephropathy progression in
type 2 diabetic patients. |
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Keywords: | Albuminuria Ambulatory blood pressure Hypertension Nephropathy Non-dipping Pulse pressure |
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