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Hypertension. 2006;47:955-961
Published online before print April 3, 2006, doi: 10.1161/01.HYP.0000216634.73504.7d
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(Hypertension. 2006;47:955.)
© 2006 American Heart Association, Inc.

Original Articles

Office and Ambulatory Blood Pressure Are Independently Associated With Albuminuria in Older Subjects With Type 2 Diabetes

Andrew Moran; Walter Palmas; Thomas G. Pickering; Joseph E. Schwartz; Lesley Field; Ruth S. Weinstock; Steven Shea

From the Department of Medicine (A.M.), University of California at San Francisco; General Internal Medicine Section (A.M.), San Francisco Veterans Affairs Medical Center, Calif; Department of Medicine (W.P., T.G.P., L.F., S.S.), Department of Biomedical Informatics (S.S.), and Behavioral Cardiovascular Health and Hypertension Program (T.G.P.), and Department of Epidemiology, Joseph Mailman School of Public Health (S.S.), Columbia University, New York, NY; Department of Psychiatry and Behavioral Science (J.E.S.), State University of New York at Stony Brook; Joslin Diabetes Center and Division of Endocrinology, Diabetes and Metabolism (R.S.W.), State University of New York Upstate Medical University, Syracuse; and Department of Veterans Affairs (R.S.W.), VA Medical Center, Syracuse.

Correspondence to Steven Shea, Division of General Medicine, 622 W 168th St, PH 9-East, New York, NY 10032. E-mail ss35{at}columbia.edu

Blood pressure strongly predicts microalbuminuria and later progression to renal failure in people with diabetes. Ambulatory blood pressure monitoring seems to be superior to office blood pressure in predicting progression to microalbuminuria in type 1 diabetes. The associations of ambulatory blood pressure with office blood pressure and microalbuminuria in type 2 diabetes remain unclear. We studied the association of office blood pressure taken with an automated device and ambulatory blood pressure with spot urine albumin:creatinine ratio in 1180 older people with type 2 diabetes participating in the Informatics for Diabetes Education and Telemedicine Study. Office and awake systolic blood pressure were independently associated with albuminuria (P<0.001 for both) in a multivariate linear regression analysis that adjusted for age, gender, duration of diabetes, hemoglobin A1c, number of antihypertensive medications, and use of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. Twelve percent of participants had well-controlled office blood pressure but not ambulatory blood pressure, whereas 14% had well-controlled ambulatory but not office blood pressure. The prevalence of microalbuminuria and macroalbuminuria in these subgroups was intermediate between those with well-controlled or uncontrolled blood pressure by both methods. We found, in a multiethnic group of older subjects with type 2 diabetes, that office systolic blood pressure and awake systolic ambulatory blood pressure exhibited independent associations with degree of albuminuria.


Key Words: blood pressure monitoring, ambulatory • diabetes mellitus • elderly




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