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Prognostic importance of home blood pressure measurement in patients with diabetic nephropathy

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Abstract

Aims

Controlling hypertension has been revealed to be as important as controlling hyperglycemia to prevent the progression of diabetic nephropathy. Home blood pressure (HBP) measurement is useful for the treatment of hypertension. This study aimed to determine whether HBP measurement is a stronger predictor of the progression of diabetic nephropathy than clinic blood pressure (CBP) measurement.

Method

A multicenter follow-up study was performed at the Japan National Hospital Organization. A database of type 2 diabetic patients was constructed. In addition to CBP measurement patients, those using HBP were included in the database. Fifty-four patients with diabetic nephropathy were extracted from the database and analyzed. The rate of decline of the estimated glomerular filtration rate (eGFR) was calculated as the outcome. Correlations between the rate of eGFR decline and various clinical and laboratory parameters, including HBP and CBP measurement, were analyzed.

Results

The white-coat effect and reverse white-coat effect were frequently observed. The rate of eGFR decline correlated significantly with home systolic blood pressure (HSBP) measurement, but not with clinic systolic blood pressure (CSBP) measurement. Stepwise multiple linear regression analysis was performed. The rate of eGFR decline was significantly explained by the morning HSBP reading. The rate of eGFR decline was also significantly explained by the average of the morning HSBP readings during the follow-up period, the eGFR and age at baseline in the model, which included CBP and HBP measurements during the follow-up period instead of those at baseline.

Conclusion

Home blood pressure measurement is useful for predicting the prognosis of diabetic nephropathy.

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Acknowledgments

This research was executed as Research in the Policy-Based Medical Services Network for Kidney Diseases of the Japan Hospital Organization and supported by the Japan National Hospital Organization collaborative clinical research grant. We want to thank Ms. T. Takano and Ms. A. Nakayama for their valuable assistance. We also want to thank the following investigators who participated in this study: A. Soyama, N. Seki, Y. Horita, A. Hurusu, H. Seino, H. Noto, Y. Tominaga and T. Sugawara.

Conflict of interest

Nothing to declare.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, National Hospital Organization Chiba-East National Hospital, 673 Nitonachou, Chuou-ku, Chiba, Chiba, 260-8712, Japan

    M. Nishimura

  2. Hokkaido Medical Center, 5-7-1-1 Yamanote, Nishi-ku, Sapporo, Hokkaido, 063-0005, Japan

    M. Kato

  3. Chiba Medical Center, 4-1-2 Tsubakimori, Chuou-ku, Chiba, Chiba, 260-8606, Japan

    F. Shimada

  4. Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, Aichi, 460-0001, Japan

    Y. Kato

  5. Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan

    R. Todo

  6. Osaka Minami Medical Center, 2-1 Kidohigashimachi, Kauchinagano, Osaka, 586-8521, Japan

    Y. Ando

  7. Okayama Medical Center, 1711-1 Tamasu, Kita-ku, Okayama, Okayama, 701-1192, Japan

    K. Hida, I. Iseda & A. Tone

  8. Higashi-Tokushima Hospital, 1-1 Ootera Aza Oomukaikita, Itano Town, Itano, Tokushima, 779-0193, Japan

    N. Nagase

  9. Kyushu Medical Center, 1-8-1 Jigyohama, Chuou-ku, Fukuoka, Fukuoka, 810-8563, Japan

    H. Yoshizumi

  10. Kumamoto Medical Center, 1-5 Ninomaru, Kumamoto, Kumamoto, 860-0008, Japan

    K. Higashi

  11. University of Human Arts and Sciences, 1288 Magome, Iwatsuki-ku, Saitama, Saitama, 339-8539, Japan

    Y. Hoshiyama

Authors
  1. M. Nishimura
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  2. M. Kato
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  3. F. Shimada
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  4. Y. Kato
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  5. R. Todo
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  6. Y. Ando
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  7. K. Hida
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  8. I. Iseda
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  9. A. Tone
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  10. N. Nagase
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  11. H. Yoshizumi
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  12. K. Higashi
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  13. Y. Hoshiyama
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Consortia

Japan National Hospital Organization (NHO) Group

Corresponding author

Correspondence to M. Nishimura.

Additional information

Authors except for Hoshiyama Y are members of the Japan National Hospital Organization (NHO) group.

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Cite this article

Nishimura, M., Kato, M., Shimada, F. et al. Prognostic importance of home blood pressure measurement in patients with diabetic nephropathy. Diabetol Int 2, 10–18 (2011). https://doi.org/10.1007/s13340-011-0018-y

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  • DOI: https://doi.org/10.1007/s13340-011-0018-y

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