P-428: 24 hour ambulatory blood pressure monitoring in diabetic hypertensive patients with varying degrees of albuminuria

Ambulatory Blood Pressure Monitoring (ABPM) is an ideal tool for intervention studies due to its better reproducibility than the clinic measurements. Numerous studies have shown an absence of normal nocturnal decrease of blood pressure in type 1 and type 2 diabetes mellitus. This blunted nocturnal decrease has been described in transitional phase from Normoalbuminuria (NAU) to microalbuminuria (MAU) and clinical proteinuria (CP). The objective of the study was to determine the effect of albuminuria on ambulatory blood pressures using classification of the ad hoc panel of the American Society of Hypertension (Flores et al, AJH 2000). Chart analysis of 500 patients revealed 88 eligible diabetic and hypertensive patients following up at the Rush University Hypertension clinic. Blood pressues, HbA1c, renal functions, and proteinuria was recorded. 24 hour ABPMs were done using portable recorders. The automated information was downloaded and examined. Data was analyzed in 30 normoalbuminuric (NAU), 31 microalbuminuric (MAU), and 27 clinically proteinuric (CP) patients. The day time average SBP was significantly increased in clinically proteinuric group. However, the average day time DBP was not significantly different between the groups. In contrast the night time SBP and DBP was significantly increased in the clinically proteinuric group. Recommendations of ASH were useful in detecting early abnormalities and gradations in blood pressure with increasing albuminuria. Clinically it helps to initiate early antihypertensive treatment even before onset of albuminuria. (See Table)24 Hour ABPMs and Varying Degrees of Proteinuria in Diabetics Day Time Average NAU (%) MAU (%) CP (%) P Value SBP>140 mm Hg 16.7 9.29 55.6 90 mm Hg 10 19.4 29.6 NS Night time Average SBP>125 mm Hg 30 38.7 70.4 80 mm Hg 16.7 16.1 55.6