Effect of improved glycemic control on blood pressure and albuminuria of insulin-dependent diabetes without nephropathy

Effect of improved glycemic control on blood pressure and albuminuria of insulin-dependent diabetes without nephropathy

Author Ferreira, Sandra Roberta Gouvea Autor UNIFESP Google Scholar
Freire, Maria Beatriz Sayeg Autor UNIFESP Google Scholar
Vivolo, Marco Antonio Autor UNIFESP Google Scholar
Zanella, Maria Teresa Autor UNIFESP Google Scholar
Institution Universidade Federal de São Paulo (UNIFESP)
FAC MED JUNDIAI
Abstract To assess the effect of glycemic control on blood pressure (BP) and albumin excretion rate (AER) in insulin-dependent diabetes, 35 patients (age 12.6 +/- 2.7 years) and 45 matched control subjects (11.9 +/- 1.8 years) were studied at an educational camp (Study I). They were evaluated at the beginning and at the end of a 9-day program of adequate diet and exercise twice daily, which induced statistically significant reductions in urinary glucose (18 +/- 21 to 5 +/- 7 g/12 h, P<0.01) and in insulin requirement (42 +/- 20 to 31 +/- 12 U/day, P<0.01) in the diabetic group. The mean BP and AER of the diabetic patients fell from 74 +/- 11 to 69 +/- 11 mmHg, P<0.001, and from 4.9 +/- 6.0 to 2.1 +/- 2.0 mu g/min, P<0.01, and a correlation was found between AER and urinary glucose. In contrast, controls showed a lower reduction in BP and no change in AER. To evaluate the mechanisms involved in BP fall another group of 39 diabetics (age 12.7 +/- 2.1 years) was submitted to the same 9-day program and also to improved glycemic control (Study II). Changes in BP (79 +/- 11 to 76 +/- 11 mmHg, P<0.05) were slighter than in the previous study. Initial creatinine clearance was high and fell to the normal range at the end of the study (159 +/- 99 to 127 +/- 42 ml min(-1) (1.73 m(2))(-1), P<0.05). Urinary aldosterone decreased from 5.3 +/- 3.9 to 3.4 +/- 2.4 mu g/24 h (P<0.05), and fractional Na+ excretion tended to increase. Initial and final metanephrine values did not differ. Changes in mean BP did not correlate with changes in aldosterone, insulin requirement or urinary glucose, The decreases in hyperfiltration and AER may have been due to the improved glycemic control induced by this educational program. Exercise may be responsible for BP reduction in diabetics and controls. BP changes particularly in diabetics could be attributed to the inhibition of the renin-angiotensin-aldosterone system and/or to decreased insulin requirement. The contribution of a negative Na+ balance consequent to decreased plasma insulin levels to the BP fall cannot be excluded.
Keywords blood pressure
albuminuria
glycemic control
insulin-dependent diabetes
aldosterone
sympathetic system
Language English
Date 1996-04-01
Published in Brazilian Journal Of Medical And Biological Research. Sao Paulo: Assoc Bras Divulg Cientifica, v. 29, n. 4, p. 459-465, 1996.
ISSN 0100-879X (Sherpa/Romeo, impact factor)
Publisher Assoc Bras Divulg Cientifica
Extent 459-465
Access rights Closed access
Type Article
Web of Science ID WOS:A1996UE87000006
URI http://repositorio.unifesp.br/11600/43106

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