Background: Ambulatory blood pressure monitoring (ABPM) permits the observation of blood pressure (BP) in a nonmedical environment. In adults, ABPM is better related to renal damage and cardiovascular morbidity than office BP readings. In early stages of type 1 diabetes (T1DM), the role of ABPM is still controversial.
Objective and hypotheses: To detect blood pressure abnormalities using 24-h ABPM in children and adolescents with T1DM and to determine their relation with anthropometric features, renal function and metabolic control.
Methods: We enrolled 34 children and adolescents (13.32±2.56 years old, 19 males) with T1DM. We collected in all subjects: anthropometric (BMI-SDS) and metabolic data (HBA1c (%), serum lipids and vitamin D levels (ng/ml)), renal function parameters (albumin/creatinine ratio and glomerular filtration), BP during routine visit and 24-h ABPM. A patient was defined as hypertensive when BP was above 95°centile according to age, gender and height centile during a routine visit (definition A) or when, along ABPM, systolic BP was above 95°centile in more than 25% of 24 h (definition B).
Results: According to definition A, 23.5% of our patients would be classified as hypertensive, while, using ABPM, this prevalence increased to 56%. In hypertensive group (definition B), the duration of T1DM was longer than in normotensive (7.57±3.20 vs. 5.46±1.76 years, P 0.02) but no other differences in anthropometric and metabolic features were documented apart from higher levels of vitamin D in normotensive patients (14.08±7.45 vs. 20.82±6.57 ng/ml, P 0.01). Only four patients did not present the phenomena of dipping (2/4 classified as hypertensive). Considering the whole population, mean systolic and diastolic BP (mmHg/24 h) correlated with BMI-SDS (r 0.38, P 0.02) and vitamin D levels (r −0.37, P 0.04), respectively. No correlations with renal function parameters were found.
Conclusions: Observations show a high prevalence of hypertension in our cohort of children and adolescents with T1DM, but a clear link between metabolic control, renal function and BP regulation is not supported.
10 - 12 Sep 2016
European Society for Paediatric Endocrinology