Ambulatory Pulse Pressure and Progression of Albuminuria in Type 2 Diabetes

Microalbuminuria is a marker for both hypertension and diabetic complications,1 and the association between elevated blood pressure (BP) and diabetic complications is well known. Until recently, focus has been directed toward increments in diastolic rather than systolic BP. Systolic BP often rises with age, whereas diastolic BP remains unchanged or declines, resulting in a widening of the pulse pressure (PP). These hemodynamic changes, thought to be because of the development of arteriosclerosis-induced stiffness of the arteries, were until recently thought to be physiological and benign in nature. However, several randomized trials have shown substantial benefits of treating isolated systolic hypertension in elderly patients, and several studies have shown that PP is a major, independent predictor of cardiovascular events in nondiabetic subjects.2 Moreover, in nondiabetic subjects and type 2 diabetic patients, elevated PP and isolated systolic hypertension have been shown to be associated with microalbuminuria.We have demonstrated previously a strong association between ambulatory PP and microvascular and macrovascular complications in a group of middle-aged Danish type 2 diabetic subjects,3 and, in particular, the association between PP and albuminuria was very strong. We suggested that PP could be a risk factor for the progression of albuminuria in this patient group, although the cross-sectional nature of the study did not allow for any firm conclusions regarding causality.However, in this issue of Hypertension , Palmas et …