Nocturnal blood pressure may be the best early indicator of subsequent vascular complications and renal disease in diabetes, according to a report in the Sept. 12 issue of the New England Journal of Medicine.
Investigators suggest that this marker may be helpful in determining who should have early intervention and who may not need it. “In persons with type 1 diabetes, an increase in systolic blood pressure during sleep precedes the development of microalbuminuria,” write Empar Lurbe, MD, from the University of Valencia in Spain, and colleagues.
“In those whose blood pressure during sleep decreases normally, the progression from normal albumin excretion to microalbuminuria appears to be less likely.” This study involved 75 adolescents and young adults with type 1 diabetes for more than five years who still had normal urinary albumin excretion and blood pressure. These subjects had ambulatory blood-pressure monitoring at the initial evaluation and about two years later, at which time all subjects had normal urinary albumin excretion. Microalbuminuria developed subsequently in 14 subjects, although the other 61 continued to have normal urinary albumin excretion.
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