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ABSTRACT: AimsControlling hypertension has been revealed to be as important as controlling hyperglycemia to prevent the progression of diabetic
nephropathy. Home blood pressure (HBP) measurement is useful for the treatment of hypertension. This study aimed to determine
whether HBP measurement is a stronger predictor of the progression of diabetic nephropathy than clinic blood pressure (CBP)
MethodA multicenter follow-up study was performed at the Japan National Hospital Organization. A database of type 2 diabetic patients
was constructed. In addition to CBP measurement patients, those using HBP were included in the database. Fifty-four patients
with diabetic nephropathy were extracted from the database and analyzed. The rate of decline of the estimated glomerular filtration
rate (eGFR) was calculated as the outcome. Correlations between the rate of eGFR decline and various clinical and laboratory
parameters, including HBP and CBP measurement, were analyzed.
ResultsThe white-coat effect and reverse white-coat effect were frequently observed. The rate of eGFR decline correlated significantly
with home systolic blood pressure (HSBP) measurement, but not with clinic systolic blood pressure (CSBP) measurement. Stepwise
multiple linear regression analysis was performed. The rate of eGFR decline was significantly explained by the morning HSBP
reading. The rate of eGFR decline was also significantly explained by the average of the morning HSBP readings during the
follow-up period, the eGFR and age at baseline in the model, which included CBP and HBP measurements during the follow-up
period instead of those at baseline.
ConclusionHome blood pressure measurement is useful for predicting the prognosis of diabetic nephropathy.
KeywordsHome blood pressure–Diabetic nephropathy–Hypertension–Type 2 diabetes