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Maximum home BP important indicator for diabetic nephropathy
Among patients with type 2 diabetes, home-measured maximum systolic blood pressure and mean systolic BP equally predicted diabetic nephropathy, according to a study.
Recently, several studies reported not only mean home systolic BP, but also variability of home systolic BP, pulse pressure and heart rate, as indicators of a home systolic BP-albuminuria correlation, Chikako Oyabu, PhD, of the Graduate School of Medical Science at Kyoto Prefectural University of Medicine in Japan, and colleagues wrote in the study background. In addition, a recent study reported that maximum home systolic BP was better correlated with hypertensive target organ damage than mean home systolic BP in untreated, hypertensive patients, they wrote.
“Maximum [home systolic] BP can be clear at first glance, though it is complicated to accurately calculate mean [home systolic] BP from multiple [home systolic] BP self-measurement values on the logbook for physicians in clinical practice,” the researchers wrote.
In a post hoc analysis, Oyabu and colleagues analyzed data from 1,040 patients with type 2 diabetes participating in the KAMOGAWA-HBP study conducted between March 2008 and October 2012. (478 women; mean age, 66 years; mean HbA1c, 7.2%). Participants underwent triplicate morning and evening BP measurements for 14 consecutive days; the mean of three measurements in the morning or evening was taken as the mean home BP; maximum home BP was defined as the highest per-patient reading among the three morning and evening daily measurements. There was no BP criterion for study inclusion; 585 patients (56.2%) were treated with antihypertensive drugs. All participants provided blood and urine samples to assess lipid profile, HbA1c and urinary albumin excretion. Researchers compared the area under the receiver operating characteristic curve of mean or maximum home systolic BP for diabetic nephropathy.
In linear regression analyses, researchers found that the mean morning systolic BP (beta = 0.01; P < .001) and maximum morning systolic BP (beta = 0.008; P < .001) were associated with urine albumin to creatinine ratio. AUC for diabetic nephropathy was 0.667 for mean morning systolic BP (95% CI, 0.634-0.7) and 0.671 for maximum systolic morning BP (95% CI, 0.638-0.703).
In analyses that excluded the first-day BP measurements when maximum morning and evening systolic BP measurements were highest, results again showed that maximum morning systolic BP (beta = 0.008; P < .001) and maximum evening systolic BP (beta = 0.007; P < .001) were associated with logarithm of urinary albumin to creatinine ratio; AUC for diabetic nephropathy in mean morning systolic BP was 0.671 (95% CI, 0.637-0.703), and AUC for diabetic nephropathy in maximum morning systolic BP was 0.653 (95% CI, 0.619-0.685).
Results persisted in subgroup analyses stratified by use of antihypertensive medication, renin-angiotensin system blockade and age.
Maximum home systolic BP “should not be disregarded as noise, but be taken seriously as an important indicator for diabetic nephropathy in patients with type 2 diabetes,” the researchers wrote, noting that major clinical guidelines continue to recommend regular BP monitoring with treatment decisions based on mean BP. – by Regina Schaffer
Disclosures: Oyabu and five other authors report receiving grant and research support from AstraZeneca, Astellas Pharma, Bristol-Myers Squibb, Daiichi Sankyo, Eli Lilly Japan, Kyowa Hakko Kirin, Kowa Pharmaceutical, Kissei Pharmaceutical, Mitsubishi Tanabe Pharma Corp., Novo Nordisk, Nippon Chemiphar, Sanwa Kagaku Kenkyusho, Sanofi, Taisho Toyama Pharmaceutical, Ono Pharmaceutical, Takeda Pharmaceutical and Terumo.