Ambulatory pulse pressure and progression of urinary albumin excretion in older patients with type 2 diabetes mellitus.
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2006-07-21
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Abstract
We studied whether ambulatory blood pressure monitoring added to office blood pressure in predicting progression of urine albumin excretion over 2 years of follow up in a multiethnic cohort of older people with type 2 diabetes mellitus Participants in the Informatics for Diabetes Education and Telemedicine study underwent a baseline evaluation that included office and 24 hour ambulatory blood pressure measurement and a spot urine measurement of albumin to creatinine ratio ACR Measurements of albumin to creatinine ratio were repeated 1 and 2 years later In bivariate analyses ambulatory 24 hour pulse pressure was the blood pressure variable most strongly associated with follow up ACR Repeated measures mixed linear models n 1040 were built adjusting for baseline ACR ratio clustered randomization time to follow up and multiple covariates When both were entered into the model ambulatory 24 hour pulse pressure and office pulse pressure were independently associated with follow up ACR beta SE 0 010 0 002 P Under 0 001 and 0 004 0 001 P 0 002 respectively Cox proportional hazards models examined associations with progression of albuminuria in 954 participants without macroalbuminuria at baseline adjusting for all of the covariates independently associated with follow up ACR in mixed linear models Ambulatory 24 hour pulse pressure but not office pulse pressure was independently associated with progression of albuminuria P 0 015 and 0 052 respectively The adjusted hazards ratio 95 CI per each 10 mm Hg increment in ambulatory pulse pressure was 1 23 1 04 to 1 42 In conclusion ambulatory pulse pressure may provide additional information to predict progression of albuminuria in elderly diabetic subjects above and beyond office blood pressure