Morning home blood pressure may be a significant marker of nephropathy in Japanese patients with type 2 diabetes: ADVANCED-J study 1.

Abstract

A 3-year multicenter, prospective, randomized, open-label trial (ADVANCED-J) compared the effect of an increased dose of angiotensin-II receptor blocker (ARB) with that of a maintenance dose of ARB plus calcium channel blocker (amlodipine) on blood pressure (BP) control, nephropathy and atherosclerosis in patients with type 2 diabetes and hypertension in whom the usual ARB dose failed to control BP. A cross-sectional analysis using baseline data was conducted. Of 316 patients (recruited between September 2004 and December 2005), 228 patients were evaluated by multiple regression analysis using two models after randomization and exclusions. Model 1 assessed 13 baseline variables (age, sex, estimated diabetes duration, estimated hypertension duration, HbA1c, brain natriuretic peptide (BNP), high-sensitive C-reactive protein (hsCRP), triglycerides (TGs), total cholesterol (TCHO), diabetic retinopathy (DMR), systolic morning home BP (HBP), diastolic morning HBP and brachial-ankle pulse wave velocity (baPWV)) for correlation with the urinary albumin creatinine excretion rate (UACR). In model 2, systolic and diastolic morning HBP was replaced by systolic and diastolic office BP. The systolic morning HBP and systolic office BP or diastolic morning HBP and diastolic office BP correlations were weak, but significant (r=0.43 and 0.48, respectively). BNP, HbA1c, DMR and estimated diabetes duration were significantly correlated with UACR in both models 1 and 2. Although systolic office BP did not show a significant correlation with UACR in model 2, systolic morning HBP showed a significant correlation with UACR in model 1. Morning HBP, but not office BP, may be a significant marker of nephropathy in Japanese patients with type 2 diabetes.

• Authors: Yasushi Tanaka, Hiroyuki Daida, Yutaka Imai, Katsumi Miyauchi, Yasukazu Sato, Masao Hiwatari, Akira Kitagawa, Junji Kishimoto, Tsutomu Yamazaki, Ryuzo Kawamori
• Journal: Hypertension research : official journal of the Japanese Society of Hypertension (Hypertens Res) Vol. 32 Issue 9 Pg. 770-4 (Sep 2009) ISSN: 1348-4214 [Electronic] England
• PMID: 19557003 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Antihypertensive Agents
• Biomarkers
• Creatinine

Topics

• Adult
• Aged
• Aged, 80 and over
• Albuminuria (metabolism)
• Antihypertensive Agents (therapeutic use)
• Biomarkers
• Blood Pressure (physiology)
• Blood Pressure Monitoring, Ambulatory
• Creatinine (urine)
• Cross-Sectional Studies
• Diabetes Mellitus, Type 2 (complications, physiopathology)
• Diabetic Nephropathies (diagnosis, physiopathology)
• Double-Blind Method
• Female
• Humans
• Hypertension (complications, epidemiology)
• Japan
• Male
• Middle Aged
• Regression Analysis