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Optimal home SBP targets for preventing the progression of diabetic nephropathy in patients with type 2 diabetes mellitus

Ushigome, Emia; Hamaguchi, Masahidea; Matsumoto, Shinobua; Oyabu, Chikakoa; Omoto, Atsushib; Tanaka, Torub; Fukuda, Watarub; Hasegawa, Gojic; Shin-ichiMogami, d; Ohnishi, Masayoshid; Kitagawa, Yoshihirod; Sei Tsunoda, e; Oda, Yoheie; Nakamura, Naotoa; Fukui, Michiakia

doi: 10.1097/HJH.0000000000000636
ORIGINAL PAPERS: Insulin sensitivity and diabetes
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Objectives: Home blood pressure control can reduce the risk of increased urinary albumin excretion in patients with diabetes mellitus. However, the optimal home blood pressure targets to prevent the onset or progression of diabetic nephropathy are not well defined.

Methods: We performed a retrospective cohort study of 851 patients with type 2 diabetes mellitus. Logistic regression models were used to evaluate the correlations of home SBP levels with progression of diabetic nephropathy.

Results: During the follow-up of 2 years, 86 patients had progression of diabetic nephropathy. Adjusted odds ratios (95% confidence interval) for progression of diabetic nephropathy in patients with morning SBP of 120–129 mmHg [2.725 (1.074–6.917), P = 0.035], 130–139 mmHg [3.703 (1.519–9.031), P = 0.004] and in those with morning SBP equal or more than 140 mmHg [2.994 (1.182–7.581), P = 0.021] were significantly higher than that in those with morning SBP less than 120 mmHg in multiple logistic analyses.

Conclusion: The preferable morning SBP targets might be less than 120 mmHg for preventing the onset or progression of diabetic nephropathy in patients with type 2 diabetes mellitus.

aDepartment of Endocrinology and Metabolism, Kyoto Prefectural University, of Medicine, Graduate School of Medical Science

bDepartment of Endocrinology and Metabolism, Kyoto First Red Cross Hospital

cDepartment of Endocrinology and Metabolism, Kyoto Second Red Cross Hospital, Kyoto

dDepartment of Endocrinology and Metabolism, Osaka General Hospital of West Japan Railway Company, Osaka

eDepartment of Cardiology, Nishijin Hospital, Kyoto, Japan

Correspondence to Michiaki Fukui, MD, PhD, Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602–8566, Japan. Tel: +81 75 251 5505; fax: +81 75 252 3721; e-mail: sayarinapm@hotmail.com

Abbreviations: BP, blood pressure; CVD, cardiovascular disease; ESRD, end-stage renal disease; home SBP, SBP at home; HOMED-BP, Hypertension Objective Treatment Based on Measurement by Electrical Devices of Blood Pressure; JSH 2014, the Japanese Society of Hypertension Guidelines for the Management of Hypertension in 2014; NDR, no diabetic retinopathy; PDR, proliferative diabetic retinopathy; SDR, simple diabetic retinopathy; UAE, urinary albumin excretion; UKPDS, UK Prospective Diabetes Study

Received 26 January, 2015

Revised 21 March, 2015

Accepted 20 April, 2015

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