AMBULATORY BLOOD-PRESSURE AND URINARY ALBUMIN EXCRETION IN DIABETIC (NON-INSULIN-DEPENDENT AND INSULIN-DEPENDENT) HYPERTENSIVE PATIENTS - RELATIONSHIPS AT BASE-LINE AND AFTER TREATMENT BY THE ANGIOTENSIN-CONVERTING ENZYME-INHIBITOR TRANDOLAPRIL

The aim of the present study was to examine the relationships between ambulatory blood pressure (ABPM) and urinary albumin excretion (UAE) i n diabetic (non-insulin dependent [NIDDM] and insulin-dependent [IDDM] ) hypertensives at baseline and after treatment by an angiotensin conv erting enzyme (ACE) inhibitor. After a 3-week placebo period, patients were treated for 16 weeks with trandolapril, 2 to 4 mg/day. The UAE a nd blood pressure (mercury sphygmomanometer and 24-h ABPM) were measur ed at baseline and repeated on trandolapril. Predictive factors of abn ormal UAE (24-h UAE greater than or equal to 30 mg) were determined us ing univariate and multivariate analysis (logistic regression). Predic tors of UAE decrease were also searched. One hundred seventy-one patie nts entered the analysis. Baseline office BP was 164 +/-e 14/97 +/- 6 mm Hg and 24-h BP was 142 +/- 17/83 +/- 10 mm Hg. Seventy-four patient s (43%) had UAE greater than or equal to 30 mg. Independent risk facto rs for abnormal UAE were nighttime diastolic BP (odds ratio [OR] = 4.1 , confidence interval [CI] = 2.0 to 8.6, P = .0001), diabetes duration (OR = 2.4, CI = 1.1 to 5.0, P = .025), and presence of retinopathy (O R = 3.2, CI = 1.0 to 10.0, P = .047). Conversely office BP level was n ot significantly related to UAE. On treatment, office BP levels decrea sed to 143 +/- 13/82 +/- 8 mm Hg (P < .0001) and 24-h BP levels to 134 +/- 17/78 +/- 9 mm Hg (P < .0001). In the abnormal UAE group, UAE sig nificantly decreased from 76 to 50 mg/day (P = .006). After treatment, independent predictive factors of abnormal UAE were: on-drug fasting plasma glucose (OR = 3.5, CI = 1.7 to 7.4, P = .0009) and on-drug nigh ttime diastolic BP (OR = 3.5, CI = 1.7 to 7.4, P = .001). The only pre dictor of UAE decrease was a 24-h systolic BP decrease (OR = 2.3, CI = 1.3 to 4.3, P = .007). We conclude that in diabetic hypertensives wit h abnormal UAE, trandolapril exhibited a sustained 24-h antihypertensi ve effect and provided a consistent reduction of microalbuminuria. Thi s study confirmed the superiority of ABPM over clinical BP to predict target organ damage. Am J Hypertens 1998;11:1065-1073 (C) 1998 America n Journal of Hypertension, Ltd.