Les mesures ambulatoires de la pression artérielle sont liées à l’excrétion d’albumine et sont prédictives du risque de survenue d’une microalbuminurie chez les sujets jeunes avec un DT1

Abstract

Aims/hypothesis

The relationship between BP and microalbuminuria in young people with type 1 diabetes is not completely clear. As microalbuminuria is preceded by a gradual rise in albumin excretion within the normal range, we hypothesised that ambulatory BP (ABP) may be closely related to albumin excretion and progression to microalbuminuria.

Methods

ABP monitoring (ABPM) was performed in 509 young people with type 1 diabetes (age median [range]: 15.7 [10.7–22.6] years) followed with annual assessments of three early morning urinary albumin/creatinine ratios (ACRs) and HbA1c. Systolic BP (SBP) and diastolic BP (DBP) and the nocturnal fall in BP were analysed in relation to ACR.

Results

All ABPM variables were significantly related to baseline log₁₀ ACR (P < 0.001). After the ABPM evaluation, 287 patients were followed for a median of 2.2 years (1.0–5.5). ABP at baseline was independently related to mean ACR during follow-up. Nineteen initially normoalbuminuric patients developed microalbuminuria after 2.0 (0.2–4.0) years and their baseline daytime DBP was higher than in normoalbuminuric patients (P < 0.001). After adjusting for baseline ACR and HbA1c, there was an 11% increased risk of microalbuminuria for each 1 mmHg increase in daytime DBP. Forty-eight percent of patients were non-dippers for SBP and 60% for DBP; however, ACR was not different between dippers and non-dippers and there were no differences in the nocturnal fall in BP between normoalbuminuric and future microalbuminuric patients.

Conclusions/interpretation

In this cohort of young people with type 1 diabetes, ABP was significantly related to ACR, and daytime DBP was independently associated with progression to microalbuminuria. Increasing albumin excretion, even in the normal range, may be associated with parallel rises in BP.