Albuminuria is a risk factor for kidney disease progression and cardiovascular events. There are strong links between high blood pressure (BP), diabetes and increased albuminuria. Studies suggest that loss of the normal night time dip in BP (non-dipping) may alter albuminuria and could be a treatment target to slow kidney damage and reduce cardiovascular risk. Damage to a lining of the blood vessels called the glycocalyx is thought to be involved in the development of albuminuria and could further understanding of albuminuria pathophysiology. This thesis aims to further understanding of these closely linked conditions by exploring the relationship between 24-hour blood pressure patterns, albuminuria and glycocalyx integrity in newly diagnosed hypertensive patients and in type 2 diabetes (T2DM). The primary aim is to determine whether loss of the normal night time blood pressure dip contributes to urine albumin excretion using an albumin assay which enables quantification of urine albumin in all participants. Twenty-four hour BP, sublingual glycocalyx integrity and urinary albumin data were derived from two studies. Data were acquired prospectively from 34 participants with T2DM within the observational BEAT-DKD study and a retrospective analysis was undertaken on data collected from 54 treatment naïve patients with grade II hypertension within the 18 week interventional DASHER trial (2015-16). The treatment protocol significantly reduced albumin excretion rate (AER) (p=0.0311). There were no observed relationships with night time blood pressure dipping and AER in the hypertensive or T2DM cohort. In the hypertensive cohort, systolic, diastolic and mean arterial BP were associated with AER. In the diabetic cohort there were no correlations with AER and average systolic BP (Rs: 0.2072, p=0.2397) and pulse pressure (Rs: 0.2398, p=0.1719), but strong correlations with night time BP variability in those with moderately increased albuminuria (AER >20µg/min) (Rs: 0.6553, p=0.0032). Glycocalyx integrity showed no relationship with albuminuria or 24-hour blood pressure. In conclusion, loss of normal night time BP dipping showed no relationship with albuminuria. Sublingual glycocalyx integrity showed no relevance to albuminuria or blood pressure. Systolic, diastolic, mean arterial pressure and pulse pressure show the strongest relationship with albuminuria but BP variability may be informative of albuminuria risk in diabetes
