Evolution of circadian blood pressure and urinary albumin excretion according to the type of diabetes over a 10-year period

The aim of the present study was to evaluate the circadian blood pressure and rinary albumin excretion (UAE) according to the type of diabetes over a 10-year period. Patients and methods: this study is based on 43 diabetic patients, 24 type 1 and 19 type 2. Ambulatory blood pressure monitoring was used to assess blood pressure at the initial evaluation (A0) and about 10 years later (A10). UAE was also checked at 10 years interval and was <30 mg/day at A0. Results: at A0, ABPM and UAE did not differ in a significant manner between type 1 and type 2 diabetics. Type 2 diabetic patients were older than type 1 (59.7+/-15.4 vs 42.9+/-12.9; p<0.0001) but the age of diabetes did not differ between the 2 groups. Between A0 and A10, there was an increase in 24 h SBP of type 1 and type 2 diabetics (type 1: 114+/-10 vs 124+/-12 mmHg: p<0.01 and type 2: 113 19 vs 135+/-13 mmHg: p<0.0001). 24 h DBR as well as BP differences (day-night) did not differ between the 2 evaluations. At A10, 24 h SBP was higher in type 2 than in type 1 (135+/-13 vs 124+/-12 mmHg; p<0.001) but differences between day and night BP were not significant. In type 1 diabetes, progression of SBP was not associated with an increase in UAE rate, while this rate increased in type 2 betwwen A0 and A10 (9+/-7 vs 70+/-101 mg/24 h; p<0.01). AT A10, UAE was higher in type 2 than in type 1 diabetes (70+/-101 vs 14+/-31 mg/24 h; p<0.02). In type 2 diabetes, the progression of UAE was correlated with SBP at A10 (r=0.495: p<0.03). Conclusion: the increase in BP levels and in UAE rate differ between type 1 and type 2 diabetes and these differnces are not due to patients age, nor to modifications in BP curves. They are probably linked to a physiopathology which could be more complex in type 2 than in type 1 diabetes.