Self-monitored BP predicts progression of diabetic kidn...

Self-monitored BP predicts progression of diabetic kidney damage better than clinic BP

Self-monitored BP predicts progression of diabetic kidney damage better than clinic BP

By: Thomas Pickering, MD, DPhil, FRCP, Director of Integrative and Behavioral Cardiology Program of the Cardiovascular Institute at Mount Sinai School of Medicine, New York.
Journal of Hypertension 1999

Diabetes, of both the adult and juvenile types, is a major cause of kidney disease and the need for dialysis. There is strong evidence that tight control of blood pressure may help to prevent or delay the kidney damage, and a lower level of blood pressure is recommended for diabetics than for non-diabetics.

A German study evaluated the use of self-monitoring of blood pressure to help to preserve kidney function in diabetics. Seventy seven patients with type 1 (juvenile onset, insulin-requiring) diabetes, all of whom had some degree of kidney damage (diabetic nephropathy) were trained to monitor their blood pressure at home every three or four days and to adjust their blood pressure medication according to the home blood pressure readings. Blood pressure was also recorded in the clinic every three or four months. Over a two year period the clinic pressure fell from 166/95 to 154/89 mmHg, and the home pressures from 159/93 to 138/83 mm Hg. The main finding of the study was that the rate of progression of kidney disease was more closely related to the self-monitored blood pressure than to the clinic blood pressure.

Doctor's comments

This is the first study to show that self-monitoring of blood pressure is of value in patients with diabetes. Recent evidence suggests that control of blood pressure may be more important than control of blood sugar in preventing the complications of diabetes, and it is ironic that blood sugar (glucose), monitoring is reimbursed, while blood pressure monitoring is not.

Where it was published

K Rave and colleagues. Value of blood pressure self-monitoring as a predictor of progression of diabetic nephropathy. Journal of Hypertension 1999; 17: 597.