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Published Online
on November 27, 2006

Hypertension. 2006
Published online before print November 27, 2006, doi: 10.1161/01.HYP.0000252431.75154.3a
A more recent version of this article appeared on January 1, 2007
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*Diabetes Type 1
*Diabetic Kidney Problems
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Submitted on August 17, 2006
Revised on September 4, 2006

Relationship Between Low-Normal Blood Pressure and Kidney Disease in Type 1 Diabetes

Anoop Shankar*; Ronald Klein; Barbara E.K. Klein; F. Javier Nieto; and Scot E. Moss

From the Department of Community, Occupational, and Family Medicine (A.S.), National University of Singapore, Singapore; and the Departments of Ophthalmology and Visual Sciences (R.K., B.E.K.K., S.E.M.) and Population Health Sciences (F.J.N.), University of Wisconsin, School of Medicine and Public Health, Madison.

* To whom correspondence should be addressed. E-mail: ashankar{at}nus.edu.sg.

Abstract--Current recommendations, largely based on studies in type 2 diabetes, suggest lower target blood pressures (BPs) for individuals with diabetes than for the general population. However, the effect of lower BP on renal outcomes in type 1 diabetes is uncertain. In a population-based cohort of type 1 diabetes adults (mean age: 33.1 years) based in Wisconsin, of which the distribution of baseline BP was in the low-normal range, we examined the relationship between decreasing categories of systolic and diastolic BP and the 16-year incidence of proteinuria (n=232 of 604) and estimated glomerular filtration rate of <60 mL/min/1.73 m2 (n=158 of 547). Decreasing BP categories had lower relative risk (RR) of developing incident proteinuria (RR comparing decreasing quartiles of systolic BP: 1.00, 0.76, 0.58, 0.73; P for trend=0.03; RR comparing decreasing quartiles of diastolic BP: 1.00, 0.81, 0.66, 0.42; P for trend <0.0001) and incident estimated glomerular filtration rate <60 mL/min/1.73 m2 (RR comparing decreasing quartiles of systolic BP: 1.00, 0.83, 0.61, 0.65; P for trend=0.03; RR comparing decreasing quartiles of diastolic BP: 1.00, 0.84, 0.82, 0.43; P for trend=0.001). These associations were independent of glycemic control and several putative confounding factors. Subjects with either systolic BP <120 mm Hg or diastolic BP <70 mm Hg had significantly lower RR (95% confidence interval) of incident proteinuria (0.63 [0.48 to 0.82]) and incident estimated glomerular filtration rate <60 mL/min/1.73 m2 (0.60 [0.43 to 0.82]); corresponding population-attributable risks for these outcomes were 26.7% and 29.5%, respectively. Our study suggests that lower BP levels, even below the accepted normal range, are protective against kidney disease in adults with type 1 diabetes. Interventional trials are desirable to clarify the clinical significance of this association.


Key words: type 1 diabetes • blood pressure • chronic kidney disease • GFR • proteinuria • WESDR


Related Article:

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Hypertension 2007 49: 13-14. [Extract] [Full Text] [PDF]



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M. R. Weir
How Do You Define "Hypertension" in a Patient With Type 1 Diabetes?
Hypertension, January 1, 2007; 49(1): 13 - 14.
[Full Text] [PDF]