Increased blood pressure in diabetes: essential hypertension or diabetic nephropathy?

This study was performed to evaluate whether it is possible to distinguish between diabetics with essential hypertension and diabetics with elevated blood pressure due to diabetic nephropathy. We investigated 46 young diabetics, 21 having incipient nephropathy defined as urinary albumin excretion (UAE) persistently above 15 micrograms/min and total urinary protein less than 0.5 g per 24 h, and 25 patients having overt nephropathy with total protein excretion equal to or above 0.5 g per 24 h. Twenty-three patients with essential hypertension were also studied as well as 24 healthy controls. Only males and females between the age of 25 years and 40 years were included. We found a positive correlation between UAE and blood pressure (BP) but a considerable overlap in BP and UAE values between diabetics and patients with essential hypertension. However, plotting urinary albumin excretion against BP, diabetics and non-diabetics with essential hypertension could be nearly totally separated. Comparison at a similar blood pressure level, for example, mean arterial blood pressure of 125 mmHg, shows that diabetics have UAE 100 times higher than non-diabetic essential hypertensives. Conversely, UAE of 100 micrograms/min would imply that mean arterial blood pressure is about 70 mmHg higher in the non-diabetic essential hypertensives than in the diabetics. Five diabetics with normal UAE and elevated blood pressure higher or equal to 160/95 mmHg were clearly within the area of the essential hypertensive patients. Our observations indicate that it seems possible to distinguish diabetic patients with essential hypertension from diabetics with elevated blood pressure due to early or advanced nephropathy.

[1]  C. Christensen.  Rapidly Reversible Albumin and β2‐microglobulin Hyperexcretion in Recent Severe Essential Hypertension , 1983, Journal of hypertension.

[2]  E. B. Pedersen,et al.  Effect of antihypertensive treatment on urinary albumin excretion, glomerular filtration rate, and renal plasma flow in patients with essential hypertension. , 1976, Scandinavian journal of clinical and laboratory investigation.

[3]  A. Krolewski,et al.  Hypertension: The Major Risk Factor in Juvenile-onset Insulin-dependent Diabetics , 1981, Diabetes.

[4]  C. Mogensen.  Progression of nephropathy in long-term diabetics with proteinuria and effect of initial anti-hypertensive treatment. , 1976, Scandinavian journal of clinical and laboratory investigation.

[5]  C. Mogensen,et al.  Blood Pressure Changes and Renal Function in Incipient and Overt Diabetic Nephropathy , 1985, Hypertension.

[6]  G. Cappelli,et al.  Renal handling of albumin and beta-2-microglobulin in human hypertension. , 1985, Nephron.

[7]  C. Mogensen,et al.  Radioimmunoassay for urinary albumin using a single antibody. , 1970, Scandinavian journal of clinical and laboratory investigation.

[8]  H. Parving,et al.  Increased urinary albumin-excretion rate in benign essential hypertension. , 1974, Lancet.

[9]  M. Steffes,et al.  Structural-functional relationships in diabetic nephropathy. , 1984, The Journal of clinical investigation.

[10]  C. Christensen.  Abnormal albuminuria and blood pressure rise in incipient diabetic nephropathy induced by exercise. , 1984, Kidney international.

[11]  W. Kannel,et al.  The prognostic significance of proteinuria: the Framingham study. , 1984, American heart journal.

[12]  K. Ichikawa,et al.  Proteinuria and Renal Function During Antihypertensive Treatment for Essential Hypertension , 1980, Journal of the American Geriatrics Society.

[13]  H. Parving,et al.  Early detection of patients at risk of developing diabetic nephropathy. A longitudinal study of urinary albumin excretion. , 1982, Acta endocrinologica.

[14]  C. Mogensen,et al.  Predicting diabetic nephropathy in insulin-dependent patients. , 1984, The New England journal of medicine.

[15]  C. Mogensen,et al.  The Stages in Diabetic Renal Disease: With Emphasis on the Stage of Incipient Diabetic Nephropathy , 1983, Diabetes.

[16]  C. Mogensen,et al.  Effect of Antihypertensive Treatment on Progression of Incipient Diabetic Nephropathy , 1985, Hypertension.

[17]  C. Mogensen,et al.  The Course of Incipient Diabetic Nephropathy: Studies of albumin excretion and blood pressure , 1985, Diabetic medicine : a journal of the British Diabetic Association.

[18]  C. Mogensen.  Long-term antihypertensive treatment inhibiting progression of diabetic nephropathy , 1982, British medical journal.

[19]  Mogensen Ce.  Glomerular Filtration Rate and Renal Plasma Flow in Short-term and Long-term Juvenile Diabetes Mellitus , 1971 .

[20]  P. Drury,et al.  Are the WHO Criteria for Hypertension Appropriate in Young Insulin‐dependent Diabetics? , 1985, Diabetic medicine : a journal of the British Diabetic Association.

[21]  H. Keen,et al.  MICROALBUMINURIA AS A PREDICTOR OF CLINICAL NEPHROPATHY IN INSULIN-DEPENDENT DIABETES MELLITUS , 1982, The Lancet.

[22]  H. Keen,et al.  Glycaemia, arterial pressure and micro-albuminuria in Type 1 (insulin-dependent) diabetes mellitus , 1984, Diabetologia.

[23]  H. Parving,et al.  EARLY AGGRESSIVE ANTIHYPERTENSIVE TREATMENT REDUCES RATE OF DECLINE IN KIDNEY FUNCTION IN DIABETIC NEPHROPATHY , 1983, The Lancet.