Visit-to-Visit Blood Pressure Variability Is a Novel Risk Factor for the Development and Progression of Diabetic Nephropathy in PatientsWith Type 2 Diabetes HIROSHI OKADA, MD

OBJECTIVEdRecent study has suggested that not only the presence of hypertension but also the variability in systolic blood pressure (SBP) are risk factors for vascular disease and organ damage. The aim of this study was to investigate the relationship between visit-to-visit variability in SBP and change in urinary albumin excretion (UAE) or development of albuminuria in patients with type 2 diabetes. RESEARCHDESIGNANDMETHODSdWemeasured SBP in 354 consecutive patients at every visit during 1 year and calculated the coefficient of variation (CV) of SBP.We performed a follow-up study to assess change in UAE or development of albuminuria, the mean interval of which was 3.76 6 0.71 years. Then, we evaluated relationships of variability of SBP to diabetic nephropathy using multiple regression analysis and multiple Cox regression model. RESULTSdMultiple regression analysis demonstrated that CV of SBP was independently associated with change in UAE (b = 0.1758; P = 0.0108). Adjusted Cox regression analyses demonstrated that CV of SBP was associated with an increased hazard of development of albu-minuria; hazard ratio was 1.143 (95 % CI 1.008–1.302)