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The role of blood pressure variability in the development of nephropathy in type 1 diabetes

Kilpatrick, Eric S.; Rigby, Alan S.; Atkin, Stephen L.

Authors

Eric S. Kilpatrick

Alan S. Rigby A.Rigby@hull.ac.uk

Stephen L. Atkin



Abstract

OBJECTIVE - Increases in blood pressure and visit-to-visit variability have both been found to independently increase the likelihood of cardiovascular events in nondiabetic individuals. This study has investigated whether each may also influence the development of microvascular complications in type 1 diabetes by examining data from the Diabetes Control and Complications Trial (DCCT). RESEARCH DESIGN AND METHODS - Using binary longitudinal multiple logistic regression, mean systolic (SBP) and diastolic (DBP) blood pressure as well as annual visit-to-visit variability (SD.SBP and SD.DBP, respectively) was related to the risk of the development/progression of nephropathy and retinopathy in initially normotensive subjects who did not become pregnant during the DCCT. RESULTS - Mean SBP and SD.SBP were independently predictive of albuminuria (odds ratio 1.005 [95% CI 1.002-1.008], P < 0.001 and 1.093 [1.069-1.117], P < 0.001, respectively, for 1 mmHg change), although SBP variability did not add to mean SBP in predicting retinopathy (0.999 [0.985-1.013], P = 0.93). DBP variability was also independently predictive of nephropathy (1.102 [1.068-1.137], P < 0.001) and not of retinopathy (0.991 [0.971-1.010], P = 0.37). Mean SBP was poorly related to SD.SBP (r(2) < 0.01) as was mean DBP with SD. DBP (r(2) < 0.01). CONCLUSIONS - Visit-to-visit variability in blood pressure consistently independently added to mean blood pressure in predicting the risk of nephropathy, but not retinopathy, in the DCCT. This observation could have implications for the management and treatment of blood pressure in patients with type 1 diabetes.

Journal Article Type Article
Publication Date Aug 19, 2010
Journal DIABETES CARE
Print ISSN 0149-5992
Electronic ISSN 1935-5548
Publisher American Diabetes Association
Peer Reviewed Peer Reviewed
Volume 33
Issue 11
Pages 2442-2447
APA6 Citation Kilpatrick, E. S., Rigby, A. S., & Atkin, S. L. (2010). The role of blood pressure variability in the development of nephropathy in type 1 diabetes. Diabetes Care, 33(11), 2442-2447. doi:10.2337/dc10-1000
DOI https://doi.org/10.2337/dc10-1000
Keywords Internal Medicine; Endocrinology, Diabetes and Metabolism; Advanced and Specialised Nursing

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Copyright Statement
© 2010 by the American Diabetes Association.
Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.



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