Increase in nocturnal blood pressure and progression to microalbuminuria in type 1 diabetes
Increase in nocturnal blood pressure and progression to microalbuminuria in type 1 diabetes
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DOI：
10.1056/nejmoa013410
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发表时间：
2002-09-12
影响因子：
158.5
通讯作者：
Batlle, D
中科院分区：
文献类型：
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作者：
Lurbe, E;Redon, J;Batlle, D
背景：患有微量白蛋白尿的 1 型糖尿病患者在睡眠时通常会出现血压升高，但尚不清楚血压升高是与微量白蛋白尿同时发生还是先于微量白蛋白尿发生。方法：我们对 75 名患有 1 型糖尿病且尿白蛋白排泄量和血压正常五年以上的青少年和年轻人进行了监测。动态血压监测用于评估初次评估时和大约两年后的血压，此时所有受试者的尿白蛋白排泄量均正常。随后，监测受试者微量白蛋白尿的发生情况。结果：14 名受试者出现微量白蛋白尿，而其他 61 名受试者继续保持正常的尿白蛋白排泄。在最终出现微量白蛋白尿的受试者中，睡眠期间的平均（+/-SD）收缩压显着升高（从109.9+/-11.3至114.9+/-11.7毫米汞柱，P=0.01），但在白蛋白排泄正常的受试者中则没有显着升高（从106.0+/-8.8至106.4+/-14.8毫米汞柱）。研究进展为微量白蛋白尿的风险与睡眠期间收缩压与白天收缩压的比率之间的关系。用于定义夜间血压正常下降的比率为 0.9 或更低，对微量白蛋白尿的发展具有 91% 的阴性预测值。此外，比率为 0.9 或以下的受试者的微量白蛋白尿风险比比率高于 0.9 的受试者低 70%（95% 置信区间，44% 至 110%）（P=0.01）。结论：在 1 型糖尿病患者中，睡眠期间收缩压升高先于微量白蛋白尿的发生。对于睡眠期间血压正常下降的人来说，从正常白蛋白排泄进展为微量白蛋白尿的可能性似乎较小。
Background: Patients with type 1 diabetes mellitus and microalbuminuria often have elevated blood pressure while they are asleep, but it is not known whether the elevation develops concomitantly with microalbuminuria or precedes it.Methods: We monitored 75 adolescents and young adults who had had type 1 diabetes with normal urinary albumin excretion and blood pressure for more than five years. Ambulatory blood-pressure monitoring was used to assess blood pressure at the initial evaluation and about two years later, at which time all subjects had normal urinary albumin excretion. Subsequently, subjects were monitored for the development of microalbuminuria.Results: Microalbuminuria developed in 14 subjects, whereas the other 61 continued to have normal urinary albumin excretion. The mean (+/-SD) systolic pressure during sleep increased significantly in the subjects who ultimately had microalbuminuria (from 109.9+/-11.3 to 114.9+/-11.7 mm Hg, P=0.01) but not in the subjects with normal albumin excretion (from 106.0+/-8.8 to 106.4+/-14.8 mm Hg). The risk of progression to microalbuminuria was examined in relation to the ratio of systolic pressure during sleep to systolic pressure in the daytime. A ratio of 0.9 or lower, used to define a normal fall in nocturnal pressure, had a negative predictive value of 91 percent for the development of microalbuminuria. Moreover, the risk of microalbuminuria was 70 percent lower (95 percent confidence interval, 44 to 110 percent) in subjects with a ratio of 0.9 or less than in those with a ratio higher than 0.9 (P=0.01).Conclusions: In persons with type 1 diabetes, an increase in systolic blood pressure during sleep precedes the development of microalbuminuria. In those whose blood pressure during sleep decreases normally, the progression from normal albumin excretion to microalbuminuria appears to be less likely.