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

Bernardica Valent Morić1, Ivan Šamija2, Lavinia La Grasta Sabolić1

  • 1Department of Pediatrics, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia.

Annals of Pediatric Endocrinology & Metabolism
|October 6, 2022
PubMed

Insights

Type 1 diabetic children show abnormal blood pressure regulation and variability, linked to albuminuria. Nighttime diastolic blood pressure and variability predict high-normal albuminuria, while nighttime diastolic blood pressure predicts microalbuminuria in these youth.

Area of Science:

  • Pediatrics
  • Nephrology
  • Endocrinology

Background:

  • Type 1 diabetes (T1D) management requires monitoring for complications like diabetic nephropathy.
  • Ambulatory blood pressure (ABP) and blood pressure variability (BPV) are crucial indicators of cardiovascular risk.
  • Albuminuria is an early marker of diabetic kidney disease.

Purpose of the Study:

  • To analyze ambulatory blood pressure (ABP) characteristics, including blood pressure variability (BPV), in children with type 1 diabetes (T1D).
  • To investigate the association between ABP/BPV and albuminuria levels (albumin/creatinine ratio - ACR) in T1D children.
  • To identify predictors of high-normal albuminuria and microalbuminuria in this pediatric population.

Main Methods:

  • ABP monitoring was conducted on 201 T1D children and adolescents (mean age 14.7 years).
  • Albuminuria was assessed using the albumin/creatinine ratio (ACR), categorizing patients into low-normal, high-normal, or microalbuminuria.
  • Statistical analyses explored correlations between BP parameters, BPV, ACR, and demographic factors.

Main Results:

  • Elevated 24-hour and nighttime systolic and diastolic blood pressure (BP) were observed in T1D subjects compared to reference values.
  • Microalbuminuria was associated with significantly higher 24-hour, daytime, and nighttime diastolic BP.
  • Nighttime diastolic BPV was higher in high-normal albuminuria groups; age and nighttime diastolic BPV predicted high-normal albuminuria, while nighttime diastolic BP predicted microalbuminuria.

Conclusions:

  • T1D children exhibit impaired BP regulation, with many not meeting hypertension criteria but showing concerning ABP patterns.
  • Diastolic ABP and BPV are linked to increasing albuminuria levels in T1D children.
  • These findings highlight a significant connection between blood pressure dynamics and early-stage diabetic nephropathy in pediatric T1D.
Abstract

Keywords:
AlbuminuriaAmbulatory blood pressureChildType 1 diabetes mellitus

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