EVOLUTION OVER A 3-YEAR PERIOD OF TYPE-2 DIABETIC SUBJECTS BLOOD-PRESSURE ACCORDING TO THEIR MICROALBUMINURIA

The purpose of this study is to compare over a three year period blood pressure modifications of type 2 diabetic subjects who suffer of inci pient nephropathy to those who remain unharmed of this complication. P atients and method : This study population is composed of 83 normotens ive (BP <140/90 mmHg) type 2 diabetic patients not receiving cardio-va scular treatment and unharmed of nephropathy (microalbuminuria inferio r to 30 mg/24 hours). An evaluation of the diabetes mellitus is undert aken at a three year interval (AO and A3). These 83 subjects are distr ibuted in two groups according to the 24 hours microalbuminuria rate a t A3. In group I (n=60), patients whose rate is lower than 30 mg/24 ho urs and in group II (n=23), patients whose microalbuminuria is over 30 mg. For these two groups, the following elements are compared at AO a nd A3 : body mass index (BMI), systolic (SBP) and diastolic blood pres sure (DBP), serum creatinine, cholesterol and triglycerides. Results:T he two groups do not differ in age (57.1+/-12 vs 53.8+/-16.4 years), d uration of diabetes mellitus (11.7+/-8.6 vs 13.3+/-10.4 years) or body mass index (25.9+/-3.8 vs 26.2+/-4 kg/m(2)). At the time of the initi al evaluation at AO, none of the studied parameters shows a significan t difference between the two populations. Comparison of statements und ertaken at A3 shows that blood pressure of Group II patients is higher than in group I, but the difference is only significant for systolic blood pressure (132+/-12 vs 139+/-11 mmHg; p <0.01). The balance of di abetes mellitus, serum creatinine and lipid levels do not differ betwe en these two groups. The blood pressure level of Group I doesn't diffe r significantly at AO and A3 (128+/-11 vs 132+/-12 mmMg for SBP; 77+/- 9 vs 78+/-7 mmHg for DBP). On the contrary, patients who develop a nep hropathy see their blood pressure increase, but only SBP has a signifi cant risk (128+/-12 vs 139+/-11 mmHg; p <0.01). Apparition of a microa lbuminuria and increase of blood pressure of Group Il are not accompan ied by a significant variation of serum creatinine. Conclusion : This study shows that for normotensive type 2 diabetic patients the transit ion from normo to microalbuminuria is associated with increases in sys tollic blood pressure. This blood pressure modification occur early, c ontemporary of the apparition of microalbuminuria, but relationship of causality between this two factors remains to be specified.