SAT-288 Association of Mineralocorticoid Receptor Overactivation With Morning Blood Pressure and Diabetic Retinopathy Severity

Abstract Disclosure: K. Sada: None. Y. Yoshida: None. K. Shibuta: None. K. Kimoto: None. S. Nagai: None. N. Matsuda: None. T. Noguchi: None. C. Yonezu: None. N. Imaishi: None. M. Morita: None. Y. Mori: None. S. Miyamoto: None. Y. Ozeki: None. M. Okamoto: None. K. Gotoh: None. T. Masaki: None. K. Yokoyama: None. T. Kubota: None. A. Takeda: None. H. Shibata: Bayer, Inc., Daiichi Sankyo. Objective: Several studies have indicated that ambulatory blood pressure monitoring (ABPM) may predict diabetic retinopathy (DR). And we previously reported an association of high 24-hour BPs and suppressed serum renin levels with the severity of DR. However, no study on DR and ABPM has focused on morning BP. Therefore, we investigated the relationship between morning BP obtained from ABPM and serum renin levels and the severity of DR. Methods: This study enrolled patients hospitalized for treatment of diabetes mellitus. All patients were classified as having no DR, simple DR, or severe DR (preproliferative DR plus proliferative DR) based on funduscopic examination, and we measured 24-hour BP, serum active renin (ARC), aldosterone (SAC), adrenocorticotropic hormone, and cortisol levels in each group. Results: Among 119 patients, 67 had no DR, 19 had simple DR, and 33 had severe DR. Compared to patients with no or simple DR, those with severe DR showed significantly higher 24-hour BPs, including daytime and nighttime systolic and diastolic BP levels. Furthermore, patients with severe DR had significantly higher morning systolic BP (122.4 ± 16.0 mmHg vs. 113.6 ± 16.1 mmHg, P <0.01) and morning diastolic BP (80.0 ± 10.0 mmHg vs. 73.7 ± 11.4 mmHg, P <0.01) than those with no or simple DR, independent of diabetic duration, HbA1c, urinary albumin to creatinine ratio, and presence of diabetic neuropathy. Morning systolic and diastolic BPs were significantly inversely associated with ARC as were other ambulatory BP parameters. In the group taking calcium channel blockers and/or α-blockers, patients with severe DR had significantly lower ARC and higher morning systolic and diastolic BPs than those with no or simple DR. Conclusion: Severe DR was associated with higher morning BP, as well as daytime and nighttime BPs, and suppressed ARC. These findings suggest that mineralocorticoid receptor overactivation may have an impact for higher BP levels over the entire 24-hour period and the severity of DR. Presentation: Saturday, July 12, 2025