Prognostic significance of day-by-day variability of home blood pressure on progression to macroalbuminuria in patients with diabetes
| Autor: | Michiaki Fukui, Emi Ushigome, Hidetaka Ushigome, Toru Tanaka, Mai Asano, Naoto Nakamura, Masahiro Yamazaki, Goji Hasegawa, Masayoshi Ohnishi, Isao Yokota, Yohei Oda, Chikako Oyabu, Muhei Tanaka, Shinobu Matsumoto, Sei Tsunoda, Noriyuki Kitagawa |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Physiology Blood Pressure Type 2 diabetes 030204 cardiovascular system & hematology Diabetic nephropathy 03 medical and health sciences 0302 clinical medicine Internal medicine Diabetes mellitus Internal Medicine medicine Albuminuria Humans Diabetic Nephropathies Prospective Studies 030212 general & internal medicine Prospective cohort study Aged Morning business.industry Odds ratio Blood Pressure Monitoring Ambulatory Middle Aged Prognosis medicine.disease Confidence interval Cross-Sectional Studies Diabetes Mellitus Type 2 Hypertension Cohort Disease Progression Kidney Failure Chronic Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | Journal of Hypertension. 36:1068-1075 |
| ISSN: | 0263-6352 |
| DOI: | 10.1097/hjh.0000000000001657 |
| Popis: | Objectives Previously, we have shown in cross-sectional analysis of patients with type 2 diabetes mellitus that the presence of diabetic nephropathy is associated with increased home blood pressure (HBP) variability. We now examine the prognostic significance of HBP variability in substantially the same cohort. Methods We performed a prospective cohort study of type 2 diabetes patients. We analyzed 714 patients. Major exclusion criteria are missing data of urinary albumin excretion and newly prescribed or stopped renin-angiotensin system inhibitors during 2-year follow-up. Patients were instructed to perform triplicate morning and evening HBP measurements for 14 consecutive days. We computed day-by-day HBP variability as within-patient standard deviation (SD) and coefficient of variation (CV) of measurements. Results During the follow-up period of 2 years, 23 patients progressed to macroalbuminuria. The changing risk of progression to macroalbuminuria with increasing day-by-day variability of morning SBP was better depicted using smoothing spline analyses. Patients with greater SD of morning SBP tended to significantly progress to macroalbuminuria [odds ratio: 5.24 (95% confidence interval: 2.10-13.03; P > 0.001)]. Patients with greater CV of morning SBP also tended to significantly progress to macroalbuminuria [odds ratio: 3.36 (95% confidence interval: 1.39-8.12; P = 0.007)]. Conclusion Day-by-day variability of morning SBP was proven as an independent predictor for progression to macroalbuminuria in patients with type 2 diabetes. |
| Databáze: | OpenAIRE |
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