Skip to main content
SpringerLink
Log in

Parental hypertension and proteinuria in Pima Indians with NIDDM

  • Originals
  • Published:
Diabetologia Aims and scope Submit manuscript

Summary

To determine if parental hypertension is associated with proteinuria in offspring with non-insulin-dependent diabetes mellitus (NIDDM), 438 diabetic Pima Indians (172 men, 266 women) aged 20 years or more and both of their parents were examined. Hypertension was defined as a systolic blood pressure 140 mm Hg or more, diastolic blood pressure 90 mm Hg or more, or treatment with antihypertensive medicine. Sixty-three percent of the fathers and 80% of the mothers had diabetes at the time their blood pressure was measured. Families in which either parent had proteinuria, defined as a urine protein-to-creatinine ratio ≥ 0.5 g/g were excluded; 73 (16.7%) of the offspring had proteinuria. The prevalence rates of proteinuria in the offspring were similar if neither parent or only one parent had hypertension (8.9 and 9.4%, respectively), but was significantly higher if both parents had hypertension (18.8%), after adjustment for age, sex, duration of diabetes, and 2-h post-load plasma glucose concentration in the offspring and diabetes in the parents by logistic regression. The odds for proteinuria being present in the offspring if both parents had hypertension was 2.2 times (95% confidence interval, 1.2 to 4.2) that if only one parent had hypertension. When mean arterial pressure and blood pressure treatment in the offspring were added to the model the relationship remained (odds ratio =2.2; 95% confidence interval, 1.1 to 4.3). Hypertension in both parents is associated with the development of proteinuria in offspring with NIDDM. This relationship was present even when controlled for the effects of blood pressure and its treatment in the offspring.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

IDDM:

Insulin-dependent diabetes mellitus

JNC V:

Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure

MAP:

mean arterial pressure

NIDDM:

non-insulin-dependent diabetes mellitus

References

  1. Viberti GC, Keen H, Wiseman MJ (1987) Raised arterial pressure in parents of proteinuric insulin dependent diabetics. BMJ 295: 515–517

    PubMed  Google Scholar 

  2. Krolewski AS, Canessa M, Warram JH et al. (1988) Predisposition to hypertension and susceptibility to renal disease in insulin-dependent diabetes mellitus. N Engl J Med 318: 140–145

    PubMed  Google Scholar 

  3. Barzilay J, Warram JH, Bak M, Laffel LMB, Canessa M, Krolewski AS (1992) Predisposition to hypertension: risk factor for nephropathy and hypertension in IDDM. Kidney Int 41: 723–730

    PubMed  Google Scholar 

  4. Chase HP, Garg SK, Harris S, Hoops SL, Marshall G (1990) High-normal blood pressure and early diabetic nephropathy. Arch Intern Med 150: 639–641

    Article  PubMed  Google Scholar 

  5. Yip J, Mattock M, Sethi M, Morocutti A, Viberti GC (1993) Insulin resistance in family members of insulin-dependent diabetic patients with microalbuminuria. Lancet 341: 369–370 (Letter)

    Article  Google Scholar 

  6. Canessa M, Adragna N, Solomon HS, Connolly TM, Tosteson DC (1980) Increased sodium-lithium countertransport in red cells of patients with essential hypertension. N Engl J Med 302: 772–776

    PubMed  Google Scholar 

  7. Clegg G, Morgan DB, Davidson C (1982) The heterogeneity of essential hypertension. Relation between lithium efflux and sodium content of erythrocytes and a family history of hypertension. Lancet II:891–894

    Article  Google Scholar 

  8. Mangili R, Bending JJ, Scott G, Li LK, Gupta A, Viberti GC (1988) Increased sodium-lithium countertransport activity in red cells of patients with insulin-dependent diabetes and nephropathy. N Engl J Med 318: 146–150

    PubMed  Google Scholar 

  9. Walker JD, Tariq T, Viberti GC (1990) Sodium-lithium countertransport activity in red cells of patients with insulin dependent diabetes and nephropathy and their parents. BMJ 301: 635–638

    PubMed  Google Scholar 

  10. Kunzelman CL, Knowler WC, Pettitt DJ, Bennett PH (1989) Incidence of nephropathy in type 2 diabetes mellitus in the Pima Indians. Kidney Int 35: 681–687

    PubMed  Google Scholar 

  11. Nelson RG, Pettitt DJ, Baird HR et al. (1993) Pre-diabetic blood pressure predicts urinary albumin excretion after the onset of type 2 (non-insulin-dependent) diabetes mellitus in Pima Indians. Diabetologia 36: 998–1001

    PubMed  Google Scholar 

  12. Pettitt DJ, Saad MF, Bennett PH, Nelson RG, Knowler WC (1990) Familial predisposition to renal disease in two generations of Pima Indians with type 2 (non-insulin-dependent) diabetes mellitus. Diabetologia 33: 438–443

    PubMed  Google Scholar 

  13. Bennett PH, Burch TA, Miller M (1971) Diabetes mellitus in American (Pima) Indians. Lancet II:125–128

    Article  Google Scholar 

  14. World Health Organization (1985) Diabetes mellitus. Technical Report Series 727, Geneva

  15. Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (1993) The fifth report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC V). Arch Intern Med 153: 154–183

    Google Scholar 

  16. Shevky MC, Stafford DD (1923) A clinical method for the estimation of protein in urine and other body fluids. Arch Intern Med 32: 222–225

    Google Scholar 

  17. Shaw AB, Risdon P, Lewis-Jackson JD (1983) Protein creatinine index and Albustix in assessment of proteinuria. BMJ 287: 929–932

    PubMed  Google Scholar 

  18. Ginsberg JM, Chang BS, Matarese RA, Garella S (1983) Use of single voided urine samples to estimate quantitative proteinuria. N Engl J Med 309: 1543–1546

    PubMed  Google Scholar 

  19. Schwab SJ, Christensen RL, Dougherty K, Klahr S (1987) Quantitation of proteinuria by use of protein-to-creatinine ratios in single urine samples. Arch Intern Med 147: 943–944

    Article  PubMed  Google Scholar 

  20. Kleinbaum DG, Kupper LL, Morgenstern H (1982) Epidemiologic research: principles and quantitative methods. Van Nostrand Reinhold Company, New York Berkshire Melbourne Ontario, pp 419–446

    Google Scholar 

  21. Lee J (1981) Covariance adjustment of rates based on the multiple logistic regression model. J Chronic Dis 34: 415–426

    Article  PubMed  Google Scholar 

  22. Zeger SL, Liang K-Y (1986) Longitudinal data analysis for discrete and continuous outcomes. Biometrics 42: 121–130

    PubMed  Google Scholar 

  23. Khoury MJ, Beaty TH, Cohen BH (1993) Epidemiologic approaches to familial aggregation. In: Khoury MJ, Beaty TH, Cohen BH (eds) Fundamentals of genetic epidemiology. Oxford University Press, New York, pp 164–199

    Google Scholar 

  24. Jensen JS, Mathiesen ER, NØrgaard K et al. (1990) Increased blood pressure and erythrocyte sodium/lithium countertransport activity are not inherited in diabetic nephropathy. Diabetologia 33: 619–624

    PubMed  Google Scholar 

  25. Laffel L, Warram JH, Krolewski AS (1991) Increased blood pressure and erythrocyte sodium/lithium countertransport activity are not inherited in diabetic nephropathy. Diabetologia 34: 452–453 (Letter)

    PubMed  Google Scholar 

  26. Johnson B, Epstein F, Kjelsberg M (1965) Distribution and familial studies of blood pressure and serum cholesterol level in a total community-Tecumseh, Michigan. J Chronic Dis 18: 147–160

    Article  PubMed  Google Scholar 

  27. Annest JL, Sing CF, Biron P, Mongeau J-G (1979) Familial aggregation of blood pressure and weight in adoptive families. II. Estimation of the relative contributions of genetic and common environmental factors to blood pressure correlations between family members. Am J Epidemiol 110: 492–503

    PubMed  Google Scholar 

  28. Havlik RJ, Garrison RJ, Feinleib M, Kannel WB, Castelli WP, McNamara PM (1979) Blood pressure aggregation in families. Am J Epidemiol 110: 304–312

    PubMed  Google Scholar 

  29. Clarke WR, Schrott HG, Burns TL, Sing CF, Lauer RM (1986) Aggregation of blood pressure in the families of children with labile high systolic blood pressure: The Muscatine Study. Am J Epidemiol 123: 67–80

    PubMed  Google Scholar 

  30. Bengtsson B, Thulin T, Scherstén B (1979) Familial resemblance in casual blood pressure-a maternal effect? Clin Sci 57: 279–281

    Google Scholar 

  31. Wilson DK, Klesges LM, Klesges RC et al. (1992) A prospective study of familial aggregation of blood pressure in young children. J Clin Epidemiol 45: 959–969

    Article  PubMed  Google Scholar 

  32. Charles MA, Pettitt DJ, Hanson RL et al. (1994) Familial and metabolic factors related to blood pressure in Pima Indian children. Am J Epidemiol 140: 123–131

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona, USA

    R. G. Nelson, D. J. Pettitt, M. P. de Courten, R. L. Hanson, W. C. Knowler & P. H. Bennett

Authors
  1. R. G. Nelson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D. J. Pettitt
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. P. de Courten
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R. L. Hanson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. W. C. Knowler
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. P. H. Bennett
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Nelson, R.G., Pettitt, D.J., de Courten, M.P. et al. Parental hypertension and proteinuria in Pima Indians with NIDDM. Diabetologia 39, 433–438 (1996). https://doi.org/10.1007/BF00400674

Download citation

  • Received:

  • Revised:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00400674

Keywords

Search

Navigation