SYSTOLIC BLOOD-PRESSURE RELATES TO THE RATE OF PROGRESSION OF ALBUMINURIA IN NIDDM

We prospectively followed a cohort of 278 non-insulin-dependent (NIDDM ) patients for a 6-year period, intending to estimate the rate of incr ease of albuminuria and to identify clinical variables that influence this increase. At baseline, normoalbuminuria (N) was seen in 74 %, mic roalbuminuria (M) in 19 % and 7 % presented with proteinuria (P). A to tal of 80 patients died; they were older (p < 0.001) and had higher al bumin excretion both at baseline and as an average during follow-up (p < 0.01). At baseline, patients with proteinuria had higher blood pres sures (systolic and diastolic), where as there was no difference betwe en patients with normo- and microalbuminuria. Glycaemic control was in creasingly poor throughout the three groups. At follow-up, an average relative rate of increase of albuminuria (slope) of 17 % per year was seen both for patients with complete 6-years, follow-up (n = 135) and patients with at least 4 years follow-up (n = 178). Slope correlated s ignificantly with systolic blood pressure (r = 0.26 and 0.29) in both groups, diastolic blood pressure only in the 4-year group (r = 0.22) a nd average albuminuria in both (r = 0.31 and 0.24). By multiple regres sion analyses systolic blood pressure and average albuminuria remained with significant influence on slope. Progression was defined as an in crease in the category (e.g. normoto microalbuminuria) as well as an i ncrease of more than 20 % in albumin excretion, and was seen in 46 pat ients with at least 4 years' follow-up. Progressors (patients demonstr ating progression) had higher systolic blood pressure (165 mm Hg +/- 2 0 vs 156 +/- 17) and poorer glycaemic control (HbA(1c): 8.2 % +/- 1.5 vs 7.7 +/- 1.3) p < 0.05, as well as a higher level of albuminuria at baseline. The present study points to systolic blood pressure and gene ral level of albuminuria as factors determining the rate of progressio n of albuminuria. However, only a modest fraction of the variation bet ween subjects was explained by these variables.