Relative nocturnal hypertension in children with insulin‐dependent diabetes mellitus

Abstract

Twenty-four-hour blood pressure and heart rate measurements were carried out in 14 newly diagnosed diabetics and in 28 diabetics with 5-13 years' duration of the disease; 8 healthy children were used as controls. Mean arterial blood pressure increased at night in 5, decreased slightly (less than 10%) in 5 and decreased markedly (more than 10%) in 18 diabetics with longer duration of the disease. The diurnal-nocturnal differences in heart rates were significantly lower in diabetics with relative "nocturnal hypertension" compared to the control group (p < 0.05). A significant negative correlation was found between maximal arterial blood pressure during physical exercise and the diurnal-nocturnal differences in mean arterial blood pressure in diabetics (r = -0.58; p < 0.02). In conclusion, we found elevated nocturnal blood pressure in a subgroup of children with longer duration of diabetes and without increased albumin excretion. However, longitudinal studies of blood pressure profiles are needed to identify the candidates for diabetic vasculopathy among diabetic children.

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

“…Similar values of diurnal-nocturnal differences were obtained by other investigators studying healthy subjects in the same age range (14). Such decreases in BP and HR have been attributed to the dominating parasympathetic tone during the night (1).…”

“…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).…”

Cardiovascular autonomic dysfunction in diabetes mellitus.

“…This finding suggests that during the course of diabetes parasympathetic dysfunction may appear earlier than sympathetic damage, as has been suggested elsewhere.2' However, the deep breathing test proved to be most sensitive in detecting autonomic neuropathy, and this could be the explanation for the high prevalence of abnormal findings in this test observed in our study. 22 23 It has been suggested that adult diabetic patients with impaired autonomic nervous system function have an increased mortality rate compared to the general diabetic population and they are at greater risk for sudden death and arrhythmias.32425 Recently, an association between abnormal cardiovascular autonomic test results and severe hypoglycaemia was observed in young diabetic patients, and it seems that disturbed autonomic function may contribute to blood pressure alterations in children and adolescents with diabetes.26 27 Nevertheless, whether early abnormalities in autonomic function will prove accurate predictors of later symptomatic autonomic neuropathy, with its poor prognosis, is unknown at present. Further prospective studies are necessary to answer this question.…”

Effects of improvement in aerobic power on resting insulin and glucose concentrations in children

“…Besides diabetes mellitus, the list of problems includes dislipidemia (Bao et al 1996;Jiang et al 1995), hypertension (Gutin et al 1995;Madacsy et al 1994), obesity (Bao et al 1996;Mo-Svwan and Lebel 1996;Torbay et al 1985) and non-atherosclerotic cardiomyopathy (Shoemaker and Bonen 1995). Although most of these relationships have been shown to occur in adults, there is growing evidence that these health consequences are manifested around the onset of pubescence (Grant 1967;Svec et al 1992).…”