Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Nephrol. Jul 6, 2017; 6(4): 209-216
Published online Jul 6, 2017. doi: 10.5527/wjn.v6.i4.209
Exercise-induced albuminuria and circadian blood pressure abnormalities in type 2 diabetes
Aurel T Tankeu, François Folefack Kaze, Jean Jacques Noubiap, David Chelo, Mesmin Yefou Dehayem, Eugene Sobngwi
Aurel T Tankeu, François Folefack Kaze, Mesmin Yefou Dehayem, Eugene Sobngwi, Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, Yaoundé 1364, Cameroon
Aurel T Tankeu, Mesmin Yefou Dehayem, Eugene Sobngwi, National Obesity Center, Yaoundé Central Hospital, Yaoundé 1364, Cameroon
François Folefack Kaze, Division of Nephrology, University Teaching Hospital, Yaoundé 1364, Cameroon
Jean Jacques Noubiap, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town 7925, South Africa
David Chelo, Mother and Child Center of the Chantal Biya Foundation, Yaoundé 1364, Cameroon
Author contributions: Tankeu AT, Kaze FF, Dehayem MY and Sobngwi E designed and performed the research; Tankeu AT, Noubiap JJ and Sobngwi E contributed to analytic tools and analyzed the data and drafted the manuscript; Tankeu AT, Kaze FF, Noubiap JJ, Chelo D and Dehayem MY and Sobngwi E critically discussed, revised and adopted the manuscript; all the authors approved the final version of the manuscript.
Institutional review board statement: The study protocol was approved by the Institutional Ethical Research Committee of the Faculty of Medicine and Biomedical Sciences of the University of Yaoundé I in Cameroon, and was conducted in accordance with the guidelines of the Helsinki Declaration.
Informed consent statement: All participants provided informed written concern prior to study enrollment.
Conflict-of-interest statement: No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
Data sharing statement: Data are available from the corresponding author upon request at sobngwieugene@yahoo.fr.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Eugene Sobngwi, MD, MPhil, PhD, Professor of Endocrinology and Metabolic Diseases, National Obesity Center, Yaoundé Central Hospital, Yaoundé 1364, Cameroon. sobngwieugene@yahoo.fr
Telephone: +237-67-5088750
Received: March 4, 2017
Peer-review started: March 7, 2017
First decision: April 18, 2017
Revised: May 15, 2017
Accepted: May 30, 2017
Article in press: May 31, 2017
Published online: July 6, 2017
Abstract
AIM

To investigate the relationship between circadian variations in blood pressure (BP) and albuminuria at rest, and during exercise in non-hypertensive type 2 diabetes (T2D) patients.

METHODS

We conducted a cross-sectional study in well controlled T2D patients, non-hypertensive, without clinical proteinuria and normal creatinine clearance. In each participant, we recorded the BP using ambulatory blood pressure monitoring (ABPM) for 24-h, and albuminuria at rest and after a standardized treadmill exercise.

RESULTS

We enrolled 27 type 2 patients with a median age of 52; and a mean duration of diabetes and HbA1c of 3.6 ± 0.8 years and 6.3% ± 0.5% respectively. Using a 24-h ABPM, we recorded a mean diurnal systolic blood pressure (SBP) of 128 ± 17 mmHg vs nocturnal of 123 ± 19 mmHg (P = 0.004), and mean diurnal diastolic blood pressure (DBP) of 83 ± 11 mmHg vs nocturnal 78 ± 14 mmHg (P = 0.002). There was a significant difference between albuminuria at rest [median = 23 mg, interquartile range (IQR) = 10-51] and after exercise (median = 35 mg, IQR = 23-80, P < 0.001). Patients with exercise induced albuminuria had an increase in nocturnal BP values on all three components (128 mmHg vs 110 mmHg, P = 0.03 for SBP; 83 mmHg vs 66 mmHg, P = 0.04; 106 vs 83, P = 0.02 for mean arterial pressure), as well as albuminuric patients at rest. Moreover, exercise induced albuminuria detect a less increase in nocturnal DBP (83 vs 86, P = 0.03) than resting albuminuria.

CONCLUSION

Exercise induced albuminuria is associated with an increase in nocturnal BP values in T2D patients.

Keywords: Albuminuria, Ambulatory measurement of blood pressure, Exercise, Type 2 diabetes mellitus

Core tip: Many studies have reported association between abnormalities in ambulatory blood pressure monitoring (ABPM) and albuminuria at rest, or the link between exercise induced albuminuria and future development of microalbuminuria. However, the relationship between exercise-induced albuminuria and nocturnal abnormalities of BP on ABPM have not been investigate. The current study aimed to investigate the potential relationship between exercise-induced albuminuria and circadian variations in BP in a sub-Saharan type 2 diabetes population. We found that exercise-induced albuminuria is associated with less important nocturnal abnormalities of BP than resting albuminuria suggesting that exercise-induced albuminuria be used to detect early abnormalities of nighttime BP.