Traditional risk factors for cardiovascular disease, including higher office and ambulatory blood pressure, were associated with greater severity of albuminuria.
Does ambulatory pulse pressure predict the progression of albuminuria in older patients with type 2 diabetes?
This editorial highlights the association between ambulatory pulse pressure and the progression of albuminuria in older patients with type 2 diabetes.
icroalbuminuria is a marker for both hypertension and diabetic complications, 1 and the association between elevated blood pressure (BP) and diabetic complications is well known.Until recently, focus has been directed toward increments in diastolic rather than systolic BP.Systolic BP often rises with age, whereas diastolic BP remains unchanged or declines, resulting in a widening of the pulse pressure (PP).These hemodynamic changes, thought to be because of the development of arteriosclerosis-induced stiffness of the arteries, were until recently thought to be physiological and benign in nature.However, several randomized trials have shown substantial benefits of treating isolated systolic hypertension in elderly patients, and several studies have shown that PP is a major, independent predictor of cardiovascular events in nondiabetic subjects.2 Moreover, in nondiabetic subjects and type 2 diabetic patients, elevated PP and isolated systolic hypertension have been shown to be associated with microalbuminuria.We have demonstrated previously a strong association between ambulatory PP and microvascular and macrovascular complications in a group of middle-aged Danish type 2 diabetic subjects, 3 and, in particular, the association between PP and albuminuria was very strong.We suggested that PP could be a risk factor for the progression of albuminuria in this patient group, although the cross-sectional nature of the study did not allow for any firm conclusions regarding causality.However, in this issue of Hypertension, Palmas et al 4 present prospective data on this subject originating from the Informatics for Diabetes Education and Telemedicine (IDEATel) Study, a large prospective study evaluating telemedicine as a means of managing the care of older (age Ն55 years) Medicare beneficiaries with diabetes residing in New York state.Ambulatory BP, urinary albumin/creatinine ratio (ACR), hemoglobin A1c, blood lipids, and so forth were assessed at baseline.As one would expect, greater severity of albuminuria was associated with traditional risk factors for cardiovascular disease (higher office and ambulatory BP, nondipping, unfavorable lipid profile, and smoking).
Knudsen et al. (2006) conducted an editorial in Type 2 Diabetes. Traditional cardiovascular risk factors (higher office and ambulatory BP, nondipping, unfavorable lipid profile, smoking) was evaluated on Severity of albuminuria. Traditional risk factors for cardiovascular disease, including higher office and ambulatory blood pressure, were associated with greater severity of albuminuria.