The Importance of Office Blood Pressure Measurement Frequency and Methodology in Evaluating the Prevalence of Hypertension in Children and Adolescents With Type 1 Diabetes: The SWEET International Database

Abstract

OBJECTIVE The prevalence of hypertension is higher in children and adolescents with type 1 diabetes (T1D) compared with those without. This retrospective analysis of a large cohort of children and adolescents with T1D from the SWEET (Better control in Pediatric and Adolescent diabeteS: Working to crEate CEnTers of Reference) international consortium of pediatric diabetes centers aimed to 1) estimate the prevalence of elevated office blood pressure (BP) and hypertension and 2) investigate the influence of BP measurement methodology on the prevalence of hypertension. RESEARCH DESIGN AND METHODS A total of 27,120 individuals with T1D, aged 5–18 years, were analyzed. Participants were grouped into those with BP measurements at three or more visits (n = 10,440) and fewer than 3 visits (n = 16,680) per year and stratified by age and sex. A subgroup analysis was performed on 15,742 individuals from centers providing a score indicating BP measurement accuracy. RESULTS Among participants with BP measurement at three or more visits, the prevalence of hypertension was lower compared with those with fewer than three visits (10.8% vs. 17.5% P < 0.001), whereas elevated BP and normotension were higher (17.5% and 71.7% vs. 15.3% and 67.1%, respectively; both P < 0.001). The prevalence of hypertension and elevated BP was higher in individuals aged ≥13 years than in younger ones (P < 0.001) and in male than female participants (P < 0.001). In linear regression models, systolic and diastolic BP was independently determined by the BP measurement methodology. CONCLUSIONS The estimated prevalence of elevated BP and hypertension in children and adolescents with T1D is ∼30% and depends on the BP measurement methodology. Less frequent BP evaluation may overestimate the prevalence of hypertension.

Increased prevalence of cardiovascular risk factors in children and adolescents with type 1 diabetes and hypertension: The SWEET international database

“…These data convey an important public health message to healthcare providers who care for children and adolescents. Early detection and prompt management of elevated BP/hypertension is crucial for preventing organ damage in children and adolescents with T1D, especially since undertreatment has been reported to be very common in this population 17 . Furthermore, early detection of additional CVRFs in this vulnerable group of young people is crucial for efficient management and thus prevention of future morbidity and mortality.…”

“…Selection of patients was performed at patient level, rather than at centre or country level. Patients without sufficient data within the study period were excluded from the analysis as well as patients receiving antihypertensive medication (n = 588), as it was unclear whether those receiving angiotensin‐converting enzyme (ACE) inhibitors for micro‐/macroalbuminuria had hypertension or not (Figure 1), as previously reported 17 . Information regarding medications other than antidiabetic, antihypertensive and lipid‐lowering drugs was not available in the SWEET database.…”