Summary
With the aim of studying the diurnal variation in blood pressure in relation to degree of fluid retention, 24-h ambulatory blood pressure monitoring was performed in 31 insulin-dependent diabetic patients with nephropathy. The extracellular volume was calculated from the distribution volume of 51Cr-EDTA after a single injection. The study population was arbitrarily divided into two groups, depending on their extracellular volume. Group 1 included 15 patients with a lower extracellular volume and group 2, 16 patients with a higher extracellular volume. Ambulatory blood pressure was measured with a portable monitor using an oscillometric technique. In all patients, the mean ±SD 24-h ambulatory blood pressure was 135/79±14/7 mm Hg. Day and night-time blood pressures were 136/81±14/7 and 133/75±17/8, respectively (p<0.02). The ambulatory blood pressure was 135/80±14/7 in group 1 and 136/78±15/6 mm Hg in group 2. The nocturnal change in blood pressure was significantly greater in group 1 than in group 2, −9/−9±10/5 mm Hg and 1/−3±10/6 mm Hg, respectively (p=0.005/0.01). There were no other significant differences between the groups than the diurnal blood pressure pattern. There were significant correlations between day ambulatory blood pressure and night ambulatory blood pressure and 24-h ambulatory blood pressure and urinary albumin excretion. There was no correlation between auscultatory clinic blood pressure on the one hand and albuminuria on the other. Latent fluid retention therefore may contribute to nocturnal hypertension in diabetic nephropathy.
Article PDF
Similar content being viewed by others
Abbreviations
- ECV:
-
Extracellular volume
- IDDM:
-
insulin-dependent diabetes mellitus
- ABP:
-
ambulatory blood pressure
References
Parving H-H, Andersen AR, Smidt UM, Hommel E, Mathiesen ER, Svendsen PA (1987) Effect of antihypertensive treatment on kidney function in diabetic nephropathy. BMJ 294: 1443–1447
Björck S, Mulec H, Johnsen SA, Nordén G, Aurell M (1992) Renal protective effect of enalapril in diabetic nephropathy. BMJ 304: 339–343
Wiegman TB, Herron KG, Chonko AM, Macdougall ML, Moore WV (1990) Recognition of hypertension and abnormal blood pressure burden with ambulatory blood pressure recordings in type I diabetes mellitus. Diabetes 39: 1556–1560
Torffvit O, Agardh C-D (1993) Day and night variation in ambulatory blood pressure in type I (insulin-dependent) diabetes mellitus with diabetic nephropathy and autonomic neuropathy. J Int Med 233: 131–137
Hansen KW, Pedersen MM, Marshall SM, Christiansen JS, Mogensen CE (1992) Circadian variation of blood pressure in patients with diabetic nephropathy. Diabetologia 35: 1074–1079
O'Brien E, O'Malley K (1990) Twenty-four hour ambulatory blood pressure monitoring: a review of validation data. J Hypertension [Suppl 6]: S11–S16
BrØchner-Mortensen J (1972) A simple method for the determination of glomerular filtration rate. Scan J Clin Lab Invest 30: 271–274
BrØchner-Mortensen J (1980) A simple single injection method for determination of the extracellular fluid volume. Scan J Clin Lab Invest 40: 567–573
BrØchner-Mortensen J (1992) The extracellular fluid volume in normal man determined as the distribution volume of [51Cr]EDTA. Scan J Clin Lab Invest 42: 261–264
Staessen JA, Fagard FH, Lijnen PG, Lutgarde T, Van Hoof R, Amery AK (1991) Mean and range of the ambulatory pressure in normotensive subjects from a meta-analysis of 23 studies. Am J Cardiol 67: 723–727
Shaw DB, Knapp MS, Davies DH (1963) Variations in blood pressure in hypertensives during sleep. Lancet I: 797:798
Littler WA, Honour AJ, Carter RD, Sleight P (1975) Sleep and blood pressure. BMJ 3: 346–348
Pickering TG, Harshfield GA, Kleinert HD, Blank S, Laragh JH (1982) Blood pressure during normal daily activities, sleep and exercise. Comparison of values in normal and hypertensive subjects. JAMA 247: 992–996
Moore WV, Donaldson DL, Chonko AM, Ideus P, Wiegmann TB (1992) Ambulatory blood pressure in type I diabetes mellitus. Comparison to presence of incipient nephropathy in adolescents and young adults. Diabetes 41: 1035–1041
Pickering TG (1991) Characterization of blood pressure variations with ambulatory monitoring. In: EO Brien, KO Mally (eds) Handbook of Hypertension, Vol 14: Blood pressure measurement. Elsevier Science Publishers, B. V. Amsterdam
Rynkiewicz A, Furmanski J, Narkiewicz K, Semetkowska E, Bieniaszewski L, Horoszek-Maziarz S, Krupa-Wojciechowska B (1993) Influence of duration of type 1 (insulin-dependent) diabetes mellitus on 24-h ambulatory blood pressure and heart rate profile. Diabetologia 36: 577 [letter]
Hornung RS, Mahler RF, Raftery EB (1989) Ambulatory blood pressure and heart rate in diabetic patients: an assessment of autonomic function. Diabet Med 6: 579–585
Mann S, Altman DG, Raftery EB, Bannister R (1983) Circadian variation of blood pressure in autonomic failure. Circulation 68: 477–483
Staessen JA, Birkenhager W, Bulpitt CJ et al. (1993) The relationship between blood pressure and sodium and potassium excretion during the day and the night. J Hypertension 11: 443–447
Mathiesen ER, Hommel E, Giese J, Parving H-H (1991) Efficacy of captopril in postponing nephropathy in normotensive insulin dependent diabetic patients with microalbuminuria. BMJ 303: 81–87
Hommel E, Parving HH, Mathiesen E, Edsberg B, DamkjÆr Nielsen, Giese J (1986) Effect of captopril on kidney function in insulin-dependent diabetic patients with nephropathy. BMJ 293: 467–470
Koren MJ, Devereux RB, Casale PN, Savage DD, Laragh JH (1991) Relation of left ventricular mass and geometry to morbidity and mortality in uncomplicated essential hypertension. Ann Int Med 114: 345–352
Pickering TG, Devereux RB (1987) Ambulatory monitoring of blood pressure as a predictor of cardiovascular risk. Am Heart J 114: 925–928
Gambardella S, Frontoni S, Spallone V et al. (1993) Increased left ventricular mass in normotensive diabetic patients with autonomic neuropathy. Am J Hypertension 6: 97–102
Hansen KW, Christensen CK, Andersen PH, Pedersen MM, Christiansen JS, Mogensen CE (1992) Ambulatory blood pressure in microalbuminuric type 1 diabetic patients. Kidney Int 41: 847–854
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Mulec, H., Blohmé, G., Kullenberg, K. et al. Latent overhydration and nocturnal hypertension in diabetic nephropathy. Diabetologia 38, 216–220 (1995). https://doi.org/10.1007/BF00400097
Received:
Revised:
Issue Date:
DOI: https://doi.org/10.1007/BF00400097