High pulse pressure linked to proteinuria in diabetes
MedWire News: High pulse pressure is associated with proteinuria in patients with diabetes in the Japanese population, report researchers.
Although previous studies have underscored the importance of pulse pressure as a risk factor for increased albuminuria, few have directly examined the impact of high pulse pressure on albuminuria with adjustment for other blood pressure (BP) components, such as systolic BP, diastolic BP, and/or mean BP levels, says the team.
In addition, no studies have investigated in a large population whether the association between high pulse pressure and albuminuria would be more prominent in patients with diabetes than in those without diabetes.
As reported in Diabetes Care, Shouichi Fujimoto (University of Miyazaki Hospital, Japan) and colleagues studied a nationwide health check-up database including information on 228,778 Japanese individuals to examine the association of high pulse pressure with proteinuria by diabetes status.
The researchers divided the population according to quintiles of pulse pressure and compared the prevalence of proteinuria (≥+1 on dipstick test) across the quintiles separately in those with diabetes, prediabetes, and normal glucose tolerance (NGT).
The researchers report that in patients with diabetes, the highest quintile of pulse pressure (≥63 mmHg) was significantly associated with proteinuria, independently of significant covariates, including systolic BP, at an odds ratio (OR) of 1.15.
When the team examined the association between pulse pressure and proteinuria in only diabetic individuals whose systolic BP was normal (<130 mmHg), the highest quintile of pulse pressure remained significantly associated with proteinuria, at an OR of 1.46.
Furthermore, the association still remained significant after adjustment for diastolic BP or mean BP at ORs of 1.61 and 1.42, respectively.
By contrast, the highest quintile of pulse pressure in those with prediabetes or NGT was not associated with proteinuria independently of systolic BP.
"Since renal autoregulation is impaired in diabetes, it may be possible that when pulse pressure is elevated, more barotrauma-induced glomerular ultrastructural changes leading to albuminuria occur in subjects with diabetes than in those without diabetes," explain Fujimoto et al.
"To confirm our findings, a prospective study as well as interventions that examine whether or not reduction of pulse pressure can enhance nephron-protective benefits in diabetes will be required," they conclude.
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By Sally Robertson