Microalbuminuria, Nondipping and Diastolic Dysfunction in Normotensive Type 2 Diabetic Patients
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Abstract
ABSTRACT
Microalbuminuria is an independent marker for cardiovascular morbidity and mor-tality however its relation with diastolic dysfunction in normotensive, well-controlled type 2 diabetic patients is not clearly documented. In twenty normoalbuminuric and 16 microalbuminuric type 2 diabetic patients, twenty-four hour ambulatory blood pressure monitoring, left ventricular echocardiographic evaluation, 12-hour daytime and nighttime urinary albumin excretion rate measurements were performed. A 10% drop in systolic blood pressure at night was accepted as the criteria for normal dipping (dippers). Mean day/night systolic blood pressure values of normoalbu-minuric group were significantly higher than the microalbuminuric group (1.09±0.09 vs. 1.02±0.06, p=0.013). Twenty-four hour systolic blood pressures (110.3±6.3 mmHg vs. 103.5±8.8 mmHg, p=0.013, respectively) and diastolic blood pressures (79±5.1 mmHg vs. 75.1±5.1 mmHg, p=0.044, respectively) were significantly higher in nondippers compared to dippers. Diastolic dysfunction rates didnt differ significantly between normo- and microalbuminuric groups (40% (8/20) vs. 43.8% (7/16), respectively, p>0.05). Microalbuminuria wasnt related with a more atherogenic lipid profile, increased rate of retinopathy and higher left ventricular mass index. These results indicate that, even in normotensive and well-controlled type 2 diabetic patients, microalbuminuria is related to nondipping. However, similar diastolic dysfunction rates between normo- and microalbuminuric subjects suggest that, good metabolic control in the presence of normotension may alleviate the increased likelihood of diastolic dysfunction and higher left ventricular mass index attributed to micro-albuminuria and nondipping in the previous studies.
Microalbuminuria is an independent marker for cardiovascular morbidity and mor-tality however its relation with diastolic dysfunction in normotensive, well-controlled type 2 diabetic patients is not clearly documented. In twenty normoalbuminuric and 16 microalbuminuric type 2 diabetic patients, twenty-four hour ambulatory blood pressure monitoring, left ventricular echocardiographic evaluation, 12-hour daytime and nighttime urinary albumin excretion rate measurements were performed. A 10% drop in systolic blood pressure at night was accepted as the criteria for normal dipping (dippers). Mean day/night systolic blood pressure values of normoalbu-minuric group were significantly higher than the microalbuminuric group (1.09±0.09 vs. 1.02±0.06, p=0.013). Twenty-four hour systolic blood pressures (110.3±6.3 mmHg vs. 103.5±8.8 mmHg, p=0.013, respectively) and diastolic blood pressures (79±5.1 mmHg vs. 75.1±5.1 mmHg, p=0.044, respectively) were significantly higher in nondippers compared to dippers. Diastolic dysfunction rates didnt differ significantly between normo- and microalbuminuric groups (40% (8/20) vs. 43.8% (7/16), respectively, p>0.05). Microalbuminuria wasnt related with a more atherogenic lipid profile, increased rate of retinopathy and higher left ventricular mass index. These results indicate that, even in normotensive and well-controlled type 2 diabetic patients, microalbuminuria is related to nondipping. However, similar diastolic dysfunction rates between normo- and microalbuminuric subjects suggest that, good metabolic control in the presence of normotension may alleviate the increased likelihood of diastolic dysfunction and higher left ventricular mass index attributed to micro-albuminuria and nondipping in the previous studies.