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Microalbuminuria and pulse pressure are powerful predictors of 25-year mortality in type 1 diabetes
38A
ORALS: Trends in Blood Pressure Control and Medications
OR-81 BLOOD PRESSURE CONTROL IN WOMEN IS IMPROVED FOLLOWING COGNITIVE BEHAVIORAL INTERVENTION ( CBI ) AND WITH THE USE OF HOME BLOOD PRESSURE MONITORING Susan P Steigerwalt, Gail Makos, Tracy Saunders, Margaret Scisney- Matlock. Hypertension and Nephrology, St. John Hospital and Medical Center, Detroit, MI; School of Nursing, University of Michigan Medical Center, Ann Arbor, MI. We studied the immediate and sustained effects of cognitive-behavioral intervention(CBI) on blood pressure control. The CBI is a 30 day home based self-learning program involving reading tailored messages designed build knowledge (cognitive representations) to improve medication taking behavior and enhance patients sense of control.We hypothesized that those receiving CBI and home blood pressure monitoring (HBP) (n⫽64),vs HBP alone (n⫽62), would show greater immediate reductions in blood pressure after a 30 day, ( morning and evening) recording of HBP with OMRON monitors, and sustained reductions in blood pressures measured at 90 days post initiation of CBI, using the 24 hour ABPM( Spacelabs 90207). We studied these interventions on ethnically diverse populations of women who were part of a larger study. Data gathered from 126 of those repeating 24h ABPM (baseline and 90 days) were used for this study. Women ages 31-83, 40% African American(aa), were randomly assigned to CBI and HBP or HBP alone. All volunteers used the medical electronic monitoring system( MEMS) to ascertain medication adherence. At baseline ABPM (mean⫾SD) were 131;⫾13.5 /81⫾11.5 and average first 5 day home blood pressures131⫾16 /78.⫾9.64, mmHg, respectively, and there were no significant differences of blood pressure by group assignment. 90 day repeat ABPM were significantly lower (p⬍0.05) in both CBI and HBP monitoring groups compared to baseline although the differences were small. For CBI group ABPM mean differences from basesline were -7.5⫾13.5/2.0⫾ 9.0, as compared to HPB only group-5.0⫾1.0/2.0⫾1.05, mmHg, respectivly. There were no significant baseline differences between ethnic groups. However, aa women in the HBP only group showed a greater response than the CBI group. Whereas, white American women benefited more from the CBI. Blood pressure control improved in all women who had uncontrolled BP at baseline regardless of group assignment (-10.4⫾12.85/-3.90⫾74mmHg). Home monitoring improves BP control in a population at great risk for cardiovascular disease, and needs to be utilized widely. These data support the usefullness of structured self care activities to improve blood pressure control overall. Further study is needed to determine the impact of other indicators that may influence blood pressure control, including patient’s experience with HBP and health care provider type.
AJH–May 2003–VOL. 16, NO. 5, PART 2
retinopathy, glycemic control, s-creatinine, s-cholesterol, and smoking habits were determined. Three patients were lost to follow-up. All-cause mortality was 37% (99/269) over 25 years for the whole group. As indicated in the table, baseline BP and pulse pressure increased significantly with increasing albuminuria levels as did mortality over 25 y.
U-Albumin
Baseline Blood Pressure
Baseline Pulse Pressure
⬍20 mg/l (n ⫽ 202) 130/82 mmHg 48 mmHg 20–200 mg/l (n ⫽ 44) 136/86 mmHg 50 mmHg ⬎200 mg/l (n ⫽ 23) 154/98 mmHg 57 mmHg p ⬍0.001 ⬍0.02
RR Vs 25-Year Background Mortality Population 29% 52% 78% ⬍0.001
2.3 [1.8–2.9] 5.8 [3.8–8.6] 13.3 [8.3–21.9] ⬍0.001
Cox multiple regression analysis (age-stratified) identified the following significant independent predictors of all cause mortality: microalbuminuria (RR 2.8; 95% CI [1.5-5.2]), duration of diabetes (1.6 pr 10 y [1.1-2.3]), macrovascular disease at baseline (1.9; [1.1-3.79]), smoking (1.9; [1.1-3.3]), glycemic control (2.3; [1.1-4.7]), and pulse pressure (2.8; [1.3-6.3]). Systolic, diastolic and mean BP was excluded from the model as was gender, s-cholesterol, s-creatinine and retinopathy. Mortality in patients with UAC 20-200 mg/l was significantly increased compared with patients with UAC ⬍20 mg/l (p⬍0.001) and similar in patients with short (⬍16 y) and long (⬎16 y) duration (p⫽0.9, age-corrected). For comparison, age, sex, and calendar year specific mortality rates were obtained from the Danish Institute of Epidemiology. The relative risk (RR) for total mortality was significantly increased in the diabetic patients vs the background population (table). This long-term study documents that microalbuminuria, pulse pressure, glycemic control, and smoking, all potentially modifiable risk factors, are important predictors of increased mortality in type 1 diabetes. Key Words: diabetes, microalbuminuria, pulse pressure
Key Words: Patient Adherence, Clinical correlates of blood pressure control, Home Blood pressure monitoring
OR-82 MICROALBUMINURIA AND PULSE PRESSURE ARE POWERFUL PREDICTORS OF 25-YEAR MORTALITY IN TYPE 1 DIABETES Per Løgstrup Poulsen, Klavs W Hansen, Elisabeth Hjøllund, Margrethe M Nielsen, Søren T Knudsen, Carl Erik Mogensen. Medical Dep M (Diabetes & Endocrinology), Aarhus Kommunehospital, Aarhus, DK-8000 Aarhus C, Denmark. The very long-term prognostic significance of microalbuminuria and blood pressure variables for mortality in type 1 diabetes is not clarified. In 1977, 272 patients were identified through outpatients’ clinics and GP’s. The cohort constituted a representative sample of adult type 1 diabetic patients in Aarhus County. Inclusion criteria were age ⱖ15 years (mean 34⫾12.8) and duration of diabetes ⱖ 5 years (mean 18⫾10.5). Urinary albumin concentration, blood pressure, macrovascular disease, 0895-7061/03/$30.00
© 2003 by the American Journal of Hypertension, Ltd. Published by Elsevier Inc.
ORALS: Trends in Blood Pressure Control and Medications
OR-81 BLOOD PRESSURE CONTROL IN WOMEN IS IMPROVED FOLLOWING COGNITIVE BEHAVIORAL INTERVENTION ( CBI ) AND WITH THE USE OF HOME BLOOD PRESSURE MONITORING Susan P Steigerwalt, Gail Makos, Tracy Saunders, Margaret Scisney- Matlock. Hypertension and Nephrology, St. John Hospital and Medical Center, Detroit, MI; School of Nursing, University of Michigan Medical Center, Ann Arbor, MI. We studied the immediate and sustained effects of cognitive-behavioral intervention(CBI) on blood pressure control. The CBI is a 30 day home based self-learning program involving reading tailored messages designed build knowledge (cognitive representations) to improve medication taking behavior and enhance patients sense of control.We hypothesized that those receiving CBI and home blood pressure monitoring (HBP) (n⫽64),vs HBP alone (n⫽62), would show greater immediate reductions in blood pressure after a 30 day, ( morning and evening) recording of HBP with OMRON monitors, and sustained reductions in blood pressures measured at 90 days post initiation of CBI, using the 24 hour ABPM( Spacelabs 90207). We studied these interventions on ethnically diverse populations of women who were part of a larger study. Data gathered from 126 of those repeating 24h ABPM (baseline and 90 days) were used for this study. Women ages 31-83, 40% African American(aa), were randomly assigned to CBI and HBP or HBP alone. All volunteers used the medical electronic monitoring system( MEMS) to ascertain medication adherence. At baseline ABPM (mean⫾SD) were 131;⫾13.5 /81⫾11.5 and average first 5 day home blood pressures131⫾16 /78.⫾9.64, mmHg, respectively, and there were no significant differences of blood pressure by group assignment. 90 day repeat ABPM were significantly lower (p⬍0.05) in both CBI and HBP monitoring groups compared to baseline although the differences were small. For CBI group ABPM mean differences from basesline were -7.5⫾13.5/2.0⫾ 9.0, as compared to HPB only group-5.0⫾1.0/2.0⫾1.05, mmHg, respectivly. There were no significant baseline differences between ethnic groups. However, aa women in the HBP only group showed a greater response than the CBI group. Whereas, white American women benefited more from the CBI. Blood pressure control improved in all women who had uncontrolled BP at baseline regardless of group assignment (-10.4⫾12.85/-3.90⫾74mmHg). Home monitoring improves BP control in a population at great risk for cardiovascular disease, and needs to be utilized widely. These data support the usefullness of structured self care activities to improve blood pressure control overall. Further study is needed to determine the impact of other indicators that may influence blood pressure control, including patient’s experience with HBP and health care provider type.
AJH–May 2003–VOL. 16, NO. 5, PART 2
retinopathy, glycemic control, s-creatinine, s-cholesterol, and smoking habits were determined. Three patients were lost to follow-up. All-cause mortality was 37% (99/269) over 25 years for the whole group. As indicated in the table, baseline BP and pulse pressure increased significantly with increasing albuminuria levels as did mortality over 25 y.
U-Albumin
Baseline Blood Pressure
Baseline Pulse Pressure
⬍20 mg/l (n ⫽ 202) 130/82 mmHg 48 mmHg 20–200 mg/l (n ⫽ 44) 136/86 mmHg 50 mmHg ⬎200 mg/l (n ⫽ 23) 154/98 mmHg 57 mmHg p ⬍0.001 ⬍0.02
RR Vs 25-Year Background Mortality Population 29% 52% 78% ⬍0.001
2.3 [1.8–2.9] 5.8 [3.8–8.6] 13.3 [8.3–21.9] ⬍0.001
Cox multiple regression analysis (age-stratified) identified the following significant independent predictors of all cause mortality: microalbuminuria (RR 2.8; 95% CI [1.5-5.2]), duration of diabetes (1.6 pr 10 y [1.1-2.3]), macrovascular disease at baseline (1.9; [1.1-3.79]), smoking (1.9; [1.1-3.3]), glycemic control (2.3; [1.1-4.7]), and pulse pressure (2.8; [1.3-6.3]). Systolic, diastolic and mean BP was excluded from the model as was gender, s-cholesterol, s-creatinine and retinopathy. Mortality in patients with UAC 20-200 mg/l was significantly increased compared with patients with UAC ⬍20 mg/l (p⬍0.001) and similar in patients with short (⬍16 y) and long (⬎16 y) duration (p⫽0.9, age-corrected). For comparison, age, sex, and calendar year specific mortality rates were obtained from the Danish Institute of Epidemiology. The relative risk (RR) for total mortality was significantly increased in the diabetic patients vs the background population (table). This long-term study documents that microalbuminuria, pulse pressure, glycemic control, and smoking, all potentially modifiable risk factors, are important predictors of increased mortality in type 1 diabetes. Key Words: diabetes, microalbuminuria, pulse pressure
Key Words: Patient Adherence, Clinical correlates of blood pressure control, Home Blood pressure monitoring
OR-82 MICROALBUMINURIA AND PULSE PRESSURE ARE POWERFUL PREDICTORS OF 25-YEAR MORTALITY IN TYPE 1 DIABETES Per Løgstrup Poulsen, Klavs W Hansen, Elisabeth Hjøllund, Margrethe M Nielsen, Søren T Knudsen, Carl Erik Mogensen. Medical Dep M (Diabetes & Endocrinology), Aarhus Kommunehospital, Aarhus, DK-8000 Aarhus C, Denmark. The very long-term prognostic significance of microalbuminuria and blood pressure variables for mortality in type 1 diabetes is not clarified. In 1977, 272 patients were identified through outpatients’ clinics and GP’s. The cohort constituted a representative sample of adult type 1 diabetic patients in Aarhus County. Inclusion criteria were age ⱖ15 years (mean 34⫾12.8) and duration of diabetes ⱖ 5 years (mean 18⫾10.5). Urinary albumin concentration, blood pressure, macrovascular disease, 0895-7061/03/$30.00
© 2003 by the American Journal of Hypertension, Ltd. Published by Elsevier Inc.