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Arterial HTN in children with T1DM--frequent and not easy to diagnose

Terezie Suláková1, Jan Janda, Jana Cerná

  • 1Department of Pediatrics, University Hospital Ostrava and Faculty of Health Studies, University of Ostrava, 708 52 Ostrava, Czech Republic. terezie.sulakova@fnspo.cz

Pediatric Diabetes
|June 9, 2009
PubMed

Insights

Office blood pressure (OBP) is insufficient for diagnosing hypertension (HTN) in children with type 1 diabetes mellitus (T1DM). Ambulatory blood pressure monitoring (ABPM) is crucial for detecting nocturnal, white-coat, and masked HTN in this population.

Area of Science:

  • Pediatric Endocrinology
  • Cardiovascular Health
  • Diabetes Management

Background:

  • Hypertension (HTN) is a significant concern in children with type 1 diabetes mellitus (T1DM).
  • Accurate blood pressure (BP) assessment is vital for managing cardiovascular risk in T1DM.
  • Traditional office blood pressure (OBP) measurements may not fully capture BP variations.

Purpose of the Study:

  • To compare the diagnostic accuracy of OBP and ambulatory blood pressure monitoring (ABPM) for hypertension in children with T1DM.
  • To identify the prevalence of different hypertension patterns (white-coat, masked, nocturnal) in this cohort.
  • To determine the predictive value of OBP for ABPM-diagnosed hypertension.

Main Methods:

  • Analysis of OBP and ABPM data from 84 children with T1DM.
  • Calculation of standard deviation scores (SDS) for BP.
  • Evaluation of BP loads, nighttime dipping patterns, and agreement between OBP and ABPM using kappa coefficient and ROC analysis.

Main Results:

  • Hypertension was diagnosed in 51% of patients by OBP versus 29% by ABPM.
  • Poor agreement (kappa = 0.175) was observed between OBP and ABPM.
  • White-coat HTN affected 32% and masked HTN 9.5% of patients; nocturnal HTN was common.
  • Diastolic OBP showed better prediction of ABPM-detected HTN (AUC=0.71) than systolic OBP (AUC=0.58).

Conclusions:

  • OBP is inadequate for assessing hypertension in children with T1DM.
  • ABPM is essential for detecting various forms of hypertension, including nocturnal, white-coat, and masked HTN, in T1DM.
  • Children with T1DM frequently exhibit complex hypertension patterns not revealed by OBP.
Abstract

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