Most adolescents with suboptimally controlled T1D have normal mean PWV compared to a healthy reference population. Chronic hyperglycemia, not T1D duration, is the main predictor of AS in adolescents.
The inclusion of MAP in the definition of ambulatory HTN significantly increased the number of hypertensive patients. MAP may be very helpful in detecting mild HTN in patients with normal/borderline SBP and DBP.
Background: Preliminary data suggest that target organ damage (TOD) and early vascular aging (EVA) may occur in children with normal blood pressure (BP).Objectives: To analyze TOD and EVA in normotensive (BP <95th percentile on ambulatory BP monitoring) type 1 diabetes children (T1D) in comparison to healthy controls (C).Subjects: 25 T1D aged 13.9 ± 2.6 years and 22 C aged 14.0 ± 3.4 years.Methods: We analyzed age- and height-related pulse wave velocity (PWV) Z-scores and expected PWV based on age, height, and mean arterial pressure (MAP). Expected vascular age based on measured PWV was calculated from pooled pediatric and adult PWV norms. Left ventricular mass index (LVMI), estimated glomerular filtration rate (eGFR), and urinary albumin/creatinine ratio (ACR) were obtained as markers of TOD.Results: T1D and C groups did not differ in anthropometry, ambulatory, LVMI, and ACR. However, median age- and height-related PWV Z-scores were higher in T1D compared to C (1.08 vs. 0.57, p = 0.006; 0.78 vs. 0.36, p = 0.02, respectively). Mean (±SD) difference between measured and expected PWV was 0.58 ± 0.57 in T1D vs. 0.22 ± 0.59 in C, p = 0.02. The mean (±SD) difference between chronological and expected vascular age was 7.53 ± 7.74 years in T1D vs. 2.78 ± 7.01 years in C, p = 0.04.Conclusion: Increased arterial stiffness and increased intraindividual differences between expected and measured PWV as well as between chronological and expected vascular age indicate that EVA may develop in T1D children even at normal ambulatory BP levels.
Arteriální tuhost odráží vlastnosti cévní stěny. Studie u dospělých pacientů prokázaly, že arteriální tuhost je rizikovým faktorem morbidity a mortality z kardiovaskulárních příčin. V poslední době vzrůstá používání neinvazivních metod měření arteriální tuhosti, jako je rychlost pulsní vlny i v pediatrické populaci, a to jak ve výzkumu, tak v klinické praxi. S rozšířením těchto neinvazivních metod do dětského věku přibývají rychle naše znalosti o faktorech a stavech, které jsou spojeny s vzestupem arteriální tuhosti. Mezi tyto faktory patří nejen tradiční kardiovaskulární rizikové faktory, ale také stavy, jakými jsou intrauterinní růstová retardace, metabolický syndrom, obezita, diabetes mellitus a chronické onemocnění ledvin, vaskulitidy a vaskulopatie spojené s různými syndromy, kongenitální srdeční vady a některé systémové choroby. Časné rozpoznání zvýšené tuhosti arterií v dětství by mohlo vést k časné léčebné intervenci. V tomto smyslu jsou ale nezbytné longitudinální intervenční studie, které by potvrdily, že zlepšení tuhosti cév u normální i rizikové pediatrické populace povede k snížení kardiovaskulárního rizika v časné dospělosti.
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