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(Hypertension. 2006;48:301.)
© 2006 American Heart Association, Inc.

Original Articles

Ambulatory Pulse Pressure and Progression of Urinary Albumin Excretion in Older Patients With Type 2 Diabetes Mellitus

Walter Palmas; Andrew Moran; Thomas Pickering; Joseph P. Eimicke; Jeanne Teresi; Joseph E. Schwartz; Lesley Field; Ruth S. Weinstock; Steven Shea

From the Department of Medicine (W.P., L.F., S.S.), Department of Epidemiology, Joseph Mailman School of Public Health (S.S.), and Department of Biomedical Informatics (S.S.), Columbia University, New York, NY; Department of Medicine (A.M.), University of California at San Francisco; General Internal Medicine Section (A.M.), San Francisco Veterans Affairs Medical Center, Calif; Behavioral Cardiovascular Health and Hypertension Program (T.P.), Columbia University, New York, NY; Hebrew Home for the Aged at Riverdale (J.P.E., J.T.), Bronx, 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; Department of Veterans Affairs (R.S.W.), VA Medical Center, Syracuse, NY.

Correspondence to Walter Palmas, Division of General Medicine, 622 W 168th St, PH 9-East, New York, NY 10032. E-mail wp56{at}columbia.edu

We studied whether ambulatory blood pressure monitoring added to office blood pressure in predicting progression of urine albumin excretion over 2 years of follow-up in a multiethnic cohort of older people with type-2 diabetes mellitus. Participants in the Informatics for Diabetes Education and Telemedicine study underwent a baseline evaluation that included office and 24-hour ambulatory blood pressure measurement and a spot urine measurement of albumin-to-creatinine ratio (ACR). Measurements of albumin-to-creatinine ratio were repeated 1 and 2 years later. In bivariate analyses, ambulatory 24-hour pulse pressure was the blood pressure variable most strongly associated with follow-up ACR. Repeated-measures mixed linear models (n=1040) were built adjusting for baseline ACR ratio, clustered randomization, time to follow-up, and multiple covariates. When both were entered into the model, ambulatory 24-hour pulse pressure and office pulse pressure were independently associated with follow-up ACR (ß [SE]=0.010 [0.002], P<0.001, and 0.004 [0.001], P=0.002, respectively). Cox proportional hazards models examined associations with progression of albuminuria in 954 participants without macroalbuminuria at baseline, adjusting for all of the covariates independently associated with follow-up ACR in mixed linear models. Ambulatory 24-hour pulse pressure, but not office pulse pressure, was independently associated with progression of albuminuria (P=0.015 and 0.052, respectively). The adjusted hazards ratio (95% CI) per each 10-mm Hg increment in ambulatory pulse pressure was 1.23 (1.04 to 1.42). In conclusion, ambulatory pulse pressure may provide additional information to predict progression of albuminuria in elderly diabetic subjects above and beyond office blood pressure.

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

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