RELATIONSHIP BETWEEN BLOOD PRESSURE AND MICROALBUMINURIA IN ADOLESCENTS WITH TYPE 1 DIABETES MELLITUS

Abstract

The aim of this study was to determine the role of increased blood pressure (BP) in the development of incipient diabetic nephropathy in the young. In 1985 we started a comprehensive program for early delection of kidney disease in diabetic children and adolescents. This program consisted of regular measurement of urinary albumin excretion (UAE) by RIA method (every 6 months) and BP (every 3 months). Unsterile urine were excluded; BP was measured following the criteria of the American Academy of Pediatrics. Glycemic and metabolic control was assessed every 3 months by measuring HbA1c, serum cholesterol and triglycerides. During the follow-up 11 adolescents and young adults (age 14-22 yr, duration of diabetes 9.3-19.7 yr) developed persistent microalbuminuria, defined as UAE greater than 30 ug/min/1.73 m² in at least two out of three consecutive measurements; at the beginning of the study these patients had UAE and BP in the normal range (UAE: 5-12 ug/min/1.73 m²; systolic BP: 108-123 mmHg; diastolic BP: 70-82 mmHg). Diabetics with microalbuminuria had normal systolic and diastolic BP during the first year of UAE persistingly in the microalbuminuric range. A significant increase of both systolic and diastolic BP became evident during the fourth year of persistent microalbuminuria. Microalbuminuric diabetics had poorer long-term glycemic control than normoalbuminuric patients (matched for sex, age and duration of diabetes)(7-year HbA1c 9.2 ± 1.3 vs. 8.3 ± 1.2; p<0.03); serum cholesterol was higher in diabetics with microaibuminuria. Increase of BP seems to develop after that persistent microalbuminuria becomes evident; thereafter, elevated BP can contribute to the development of clinical diabetic nephropathy and end-stage renal failure.

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