Barbieri Michelangela, Rizzo Maria Rosaria, Fava Ilaria, Sardu Celestino, Angelico Nicola, Paolisso Pasquale, Abbatecola Angela, Paolisso Giuseppe, Marfella Raffaele
Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, Piazza Miraglia 2, 80138 Naples, Italy.
Evangelical Hospital Villa Betania, Naples, Italy.
J Diabetes Res. 2016;2016:5876792. doi: 10.1155/2016/5876792. Epub 2015 Dec 28.
We investigated the predictive value of morning blood pressure surge (MBPS) on the development of microalbuminuria in normotensive adults with a recent diagnosis of type 2 diabetes.
Prospective assessments of 24-hour ambulatory blood pressure monitoring and urinary albumin excretion were performed in 377 adult patients. Multivariate-adjusted Cox regression models were used to assess hazard ratios (HRs) between baseline and changes over follow-up in MBPS and the risk of microalbuminuria. The MBPS was calculated as follows: mean systolic BP during the 2 hours after awakening minus mean systolic BP during the 1 hour that included the lowest sleep BP.
After a mean follow-up of 6.5 years, microalbuminuria developed in 102 patients. An increase in MBPB during follow-up was associated with an increased risk of microalbuminuria. Compared to individuals in the lowest tertile (-0.67 ± 1.10 mmHg), the HR and 95% CI for microalbuminuria in those in the highest tertile of change (24.86 ± 6.92 mmHg) during follow-up were 17.41 (95% CI 6.26-48.42); p for trend <0.001. Mean SD MBPS significantly increased in those who developed microalbuminuria from a mean [SD] of 10.6 [1.4] to 36.8 [7.1], p < 0.001.
An increase in MBPS is associated with the risk of microalbuminuria in normotensive adult patients with type 2 diabetes.
我们研究了晨血压激增（MBPS）对近期诊断为2型糖尿病的血压正常成年人微量白蛋白尿发生的预测价值。
对377例成年患者进行了24小时动态血压监测和尿白蛋白排泄的前瞻性评估。使用多变量调整的Cox回归模型评估MBPS在基线和随访期间变化与微量白蛋白尿风险之间的风险比（HRs）。MBPS的计算方法如下：醒来后2小时内的平均收缩压减去包括最低睡眠血压在内的1小时内的平均收缩压。
平均随访6.5年后，102例患者出现微量白蛋白尿。随访期间MBPB的增加与微量白蛋白尿风险增加相关。与最低三分位数组（-0.67±1.10 mmHg）的个体相比，随访期间变化最高三分位数组（24.86±6.92 mmHg）的微量白蛋白尿的HR及95%CI为17.41（95%CI 6.26 - 48.42）；趋势p<0.001。发生微量白蛋白尿的患者平均标准差MBPS从平均[标准差]10.6[1.4]显著增加到36.8[7.1]，p<0.001。
MBPS增加与血压正常的2型糖尿病成年患者微量白蛋白尿风险相关。
