Blood pressure in children, adolescents and young adults with Type 1 (insulin-dependent) diabetes

Abstract

Summary, Blood pressure has been measured by a single observer using a standardised technique in 163 Type I (insulindependent) diabetic patients aged 4 to 32 years, 232 of their non-diabetic siblings in the same age range and in 292 of their natural parents. Results for each sex were examined separately by analysis of variance. Systolic pressures were not significantly different overall nor in any single 4-year age band. In contrast, phase IV diastolic pressure was slightly but significantly higher in the diabetic males than in their sibling group overall (increment = + 2.8 mmHg; p < 0.03), a difference also shown individually within the 16-20 year age band (81.3 versus 76.5 mmHg, p < 0.025). There were no significant differences in diastolic pressure between the female groups, and no effect of duration of diabetes on blood pressure was shown in either sex. Eighteen of 97 male diabetic patients (19%) had mean blood pressures above the 90th centile for age, derived from the sibling data, compared with 12 of 137 siblings (9%, p =0.05). The higher blood pressures among the diabetic males could not be explained solely by early nephropathy; familial factors appeared to be important in the determination of elevated blood pressure in this group as well as in the siblings. Alone, these small differences in blood pressure are unlikely to make a major contribution to the incidence of diabetic vascular disease, but the isolated increase in diastolic pressure may indicate altered vascular regulation in Type 1 diabetes.

Prevalence of Microvascular and Neurologic Abnormalities in a Population of Diabetic Children

“…Long-term strict metabolic control may delay or even prevent the progression of microalbuminuria to macroalbuminuria and overt diabetic nephropathy. Moreover, in terms of diabetic neuropathy, the recent reports from the DCCT study underline the benefit of intensive therapy in preventing the appearance of clinical neuropathy 4 . Therefore, maintenance of good metabolic control is the aim in children with IDDM, and particularly in those with early impairment of renal and neural function.…”

Abnormal nocturnal blood pressure fall in normotensive adolescents with insulin-dependent diabetes is ameliorated following glycemic improvement

“…Particularly, nocturnal hypertension may be important in terms of renal function deterioration (11). Data on BP monitoring in children and adolescents with insulin-dependent diabetes mellitus (IDDM) are limited and conflicting (12)(13)(14). Relatively elevated nocturnal BP was observed in a subgroup of normoalbuminuric diabetic children and was attributed to autonomic dysfunction (14).…”

The impact of blood pressure measurement methods on the assessment of differences in blood pressure levels between patients with normoalbuminuric type 1 diabetes and healthy controls

“…In all but one study no difference in BP was observed between healthy controls and patients with normoalbuminuric type 1 diabetes, when adjusting for albuminuria, diabetes duration, age and gender. 3,4,11,12,14,16,[25][26][27] We have used an automatic auscultatory device (Profilomat ® ) to measure 24-h BPs and found no significant difference in 'daytime' or 'night-time' BP or in systolic or diastolic day-night differences between diabetic patients and controls. These results are somewhat in contrast with data from studies in which 24-h BPs were measured with an oscillometric device.…”

“…Contrasting results have been reported regarding the prevalence of hypertension in patients with normoalbuminuric IDDM, showing either a slightly higher than expected or a normal percentage of IDDM patients with elevated BP. [7][8][9][10][11][12] Some investigators have reported that even in young diabetic patients BP is increased, 9,10 but others did not find a difference in systolic BP between diabetic children and a reference population whereas diastolic BP tended to be even lower. 11 Although most cross-sectional as well as longitudinal studies on the prevalence of elevated BP in type 1 diabetes suggest an association between microalbuminuria and BP rise, it is still controversial whether the increase of arterial BP precedes, follows or develops in parallel with the onset of microalbuminuria.…”

“…[1][2][3][4][5] Furthermore, it is unclear if in patients with type 1 diabetes an increase in BP precedes or follows the onset of microalbuminuria. 4,[6][7][8][9][10][11][12][13][14][15][16][17][18] It is clear that accurate measurements of BP are of great importance. In the various studies mentioned before, the methods of BP ± 1.5/83.7 ± 1.0 in C (NS).…”