Ambulatory 24-hour pulse pressure predicts progression of
albuminuria in persons with
diabetes mellitus. The authors assessed whether nocturnal blood pressure (BP) patterns added predictive information and examined the multivariate-adjusted association of nocturnal BP patterns with progression of urine
albumin excretion during follow-up in a multiethnic cohort of older people (n=957) with
type 2 diabetes mellitus who were free of macroalbuminuria.
Albuminuria was assessed by spot urine measurement of
albumin-to-
creatinine ratio at baseline and annually for 3 years. Participants were categorized according to their sleep/wake systolic BP ratio as dippers (ratio </=0.9; n=295), nondippers (flat nocturnal pattern, ratio >0.9 to 1; n=475), and nocturnal BP risers (ratio >1; n=187). The proportion exhibiting progression of
albuminuria in dippers, nondippers, and risers was 17.6%, 22.9%, and 27.3%, respectively (P for linear trend = .01). A nocturnal BP rise was independently associated with progression of
albuminuria (hazard ratio, 1.68; 95% confidence interval [CI], 1.09-2.60; P=.02), whereas office pulse pressure was not. When ambulatory 24-hour pulse pressure was added to the model, the nocturnal BP rise remained an independent predictor of progression of
albuminuria (hazard ratio, 1.58; 95% CI, 1.02-2.45; P=.04). Nocturnal nondipping (without BP increase) was not an independent predictor. In conclusion, nocturnal BP rise on ambulatory monitoring is superior to office BP to predict worsening of
albuminuria in elderly individuals with
type 2 diabetes and adds to the information provided by 24-hour pulse pressure.