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Blood pressure regulation determined by ambulatory blood pressure profiles in children and adolescents with type 1 diabetes mellitus: Impact on diabetic complications
Author(s) -
Dost A,
BechtoldDalla Pozza S,
Bollow E,
Kovacic R,
Vogel P,
Feldhahn L,
Schwab KO,
Holl RW
Publication year - 2017
Publication title -
pediatric diabetes
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.678
H-Index - 75
eISSN - 1399-5448
pISSN - 1399-543X
DOI - 10.1111/pedi.12502
Subject(s) - medicine , ambulatory blood pressure , type 2 diabetes mellitus , blood pressure , ambulatory , diabetes mellitus , type 1 diabetes , pediatrics , endocrinology
Background The combination of high blood pressure and hyperglycemia contributes to the development of diabetic complications. Ambulatory monitoring of blood pressure ( ABPM ) is seen as standard to assess blood pressure ( BP ) regulation. Objective We evaluated 24‐hour BP regulation in 3529 children with type 1 diabetes, representing 5.6% of the patients <20 years of age documented in the DPV registry, and studied the influence of BP parameters including pulse pressure ( PP ) and blood pressure variability ( BPV ) on microalbuminuria ( MA ) and diabetic retinopathy ( DR ). Results BP was increased in this selected cohort of children with diabetes compared to healthy German controls (standard deviation score ( SDS ) day: systolic BP ( SBP ) +0.06, mean arterial pressure ( MAP ) +0.08, PP +0.3; night: SBP +0.6, diastolic BP +0.6, MAP +0.8), while daytime diastolic BP ( SDS −0.2) and dipping of SBP and MAP were reduced ( SBP −1.1 SDS , MAP 12.4% vs 19.4%), PP showed reverse dipping (−0.7 SDS ). Children with microvascular complications had by +0.1 to +0.75 SDS higher BP parameters, except of nocturnal PP in MA and diurnal and nocturnal PP in DR . Reverse dipping of PP was more pronounced in the children with MA (−5.1% vs −0.8%) and DR (−2.6% vs −1.0%). BP alteration was stronger in girls and increased with age. Conclusion There is an early and close link between 24‐hour blood pressure regulation and the development of diabetic complications not only for systolic, diastolic, and mean arterial BP but also for the derived BP parameter PP and BPV in our selected patients.