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Increased night/day diastolic blood pressure ration is associated with high normal urinary albumin excretion and retinopathy in normotensive and normoalbuminuric type 1 diabetic patients

Background:To determine if a reduced nocturnal fall in blood pressure increases the risk of microvascular complications in normoalbuminuric and normotensive type 1 diabetics. Patients and Methods: One hundred thirty nine type 1 diabetic patients with 24h urinary albumin excretion < 30 mg/24h and casual BP <130/80 mmHg were included. Direct ophtalmoscopy and 24 h ambulatory blood pressure were performed and patients classified according to night/day diastolic and systolic BP ratio < or > 0.9 as dippers and nondippers. Results:Between the dippers (n=113) and nondippers (n=26) according to diastolic blood pressure ratio, a significant difference in 24h urinary albumin excretion (12.21 &plusmn ; 5.45 ; 18.78&plusmn ; 4.73, p= 0.001) and prevalence of nonproliferative retinopathy (44.24% ; 76.9%, p= 0.03) was found. Between the dippers (n=76) and nondippers (n=63) according to systolic blood pressure ratio, a significant difference in 24h urinary albumin excretion (10.63 &plusmn ; 4.33 ; 16.76&plusmn ; 5.8 p= 0.001), prevalence of nonproliferative retinopathy (28.9% ; 66.6%, p= 0.04) and duration of diabetes was found (9.55 &plusmn ; 8.84 ; 14 &plusmn ; 9.41, p=0.004). Night/day diastolic blood pressure ratio was related to 24h urinary albumin excretion and retinopathy (r=0.406, r=0.23). In a stepwise multiple regression analysis urinary albumin excretion was significantly associated with night/day diastolic blood pressure ratio (&#946; =0.794), retinopathy was significantly associated with night/day diastolic blood pressure ratio (&#946; =0.949) and duration of diabetes (&#946; =0.04). Conclusion: An impaired night diastolic blood pressure fall is associated with high normal urinary albumin excretion and retinopathy in normoalbuminuric and strictly normotensive type 1 diabetic patients and may be relevant to the long-term development of microvascular complications.

blood pressure ration; normoalbuminuria; retinopathy; type 1 diabetes;

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