Ambulatory blood pressure and carotid intima media thickness in children with type 1 diabetes

Abstract

Background/Objective: Blood pressure abnormalities may play an important role in macrovascular damage in type 1 diabetes. Little is known about blood pressure abnormalities and macrovascular damage in children with type 1 diabetes.Methods: Children with type 1 diabetes (n = 57) for a short (3 months-2 years; n = 24) or long duration (≥5 years; n = 33) and a group of control children without diabetes (n = 29) completed 24-h ambulatory blood pressure monitoring (ABPM).Carotid intima media thickness (cIMT), a subclinical indicator of atherosclerosis, was assessed by carotid ultrasound.Results: ABPM abnormalities were more prevalent (57% vs 24%, respectively), and daytime, nighttime and 24-h systolic, diastolic, and mean arterial blood pressure indices were higher in children with type 1 diabetes compared to control children. The odds estimate of an ABPM abnormality was 6.68 (95% confidence interval: 1.95, 22.9; P = .003) in children with type 1 diabetes compared to controls after adjusting for age, sex, and BMI standardized for age and sex (zBMI). An interaction between ABPM and zBMI on cIMT was observed. In children with type 1 diabetes and ABPM abnormalities, every 1 SD increase in zBMI was associated with a 0.030 mm increase in cIMT (95% confidence interval: 0.002, 0.041; P = .031). This was not observed in control children with ABPM abnormalities or in children with normal ABPM, regardless of type 1 diabetes status.Conclusions: Children with type 1 diabetes have a high prevalence of ABPM abnormalities independent of disease duration and this is related to early indicators of cardiovascular damage. K E Y W O R D Sambulatory blood pressure monitoring, BMI, carotid-intima media thickness, children, type 1 diabetes

Is there a characteristic pattern of ambulatory blood pressure profile in type 1 diabetic children and adolescents?

“…Similar to our results Dost et al found elevated daytime SBP and nighttime SBP and DBP compared with the historic controls (23). The high prevalence of ABP abnormalities in T1D children including 24-hour, daytime and nighttime SBP, DBP and mean arterial BP indices was also observed in recently published smaller Canadian study (24).…”

Masked Hypertension in Healthy Children and Adolescents: Who Should Be Screened?

“…Masked hypertension in T1D patients is associated with longer duration of T1D, higher insulin requirement, and unstable glycemia [ 53 ••]. Isolated nocturnal hypertension, a subtype of MH, was a predictor of carotid intima media thickness, another sign of hypertension-mediated organ damage (HMOD) [ 54 ]. Lurbe et al confirmed an association of the increase in nocturnal systolic BP and development of albuminuria during the follow-up [ 55 ].…”

Decreased Flow-Mediated Dilatation in Children With Type 1 Diabetes: A Systematic Review and Meta-Analysis

“…Our meta-analysis has demonstrated that T1DM children are strongly associated with endothelial dysfunction. It should be noted that previous studies have proved that other arterial abnormalities were demonstrated in children with T1DM, 54–57 which indicate the need for strict monitoring of cardiovascular disease risk factors and/or subclinical signs of atherosclerosis in children with T1DM. Also, higher LDL-C levels may potentially contribute to endothelial dysfunction in T1DM children.…”