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Altered blood pressure during sleep in normotensive subjects with type I diabetes
A Lurbe1, J Redón, J M Pascual
1Northwestern University Medical School, Chicago, IL 60611.
Insights
Type 1 diabetes disrupts normal blood pressure patterns in young adults, with higher nighttime blood pressure linked to microalbuminuria. This indicates early kidney damage in diabetic patients.
Area of Science:
- Cardiology
- Nephrology
- Endocrinology
Background:
- Type 1 diabetes is associated with cardiovascular complications.
- Normotensive diabetic individuals may exhibit altered circadian blood pressure patterns.
- Early detection of cardiovascular risk in diabetes is crucial.
Purpose of the Study:
- To investigate the circadian blood pressure patterns in normotensive children and young adults with type 1 diabetes.
- To determine the relationship between blood pressure regulation and urinary albumin excretion in this population.
Main Methods:
- Studied 45 patients with type 1 diabetes and 45 matched controls.
- Monitored circadian blood pressure patterns, including nocturnal blood pressure fall.
- Analyzed the correlation between sleep blood pressure and urinary albumin excretion.
Main Results:
- Diabetic children (10-14 years) had intact nocturnal blood pressure fall.
- Older diabetics (15-37 years) showed blunted nocturnal systolic and diastolic blood pressure falls.
- Higher sleep blood pressure in microalbuminuric diabetics compared to normoalbuminuric diabetics and controls (p < 0.05).
Conclusions:
- Circadian blood pressure regulation is impaired in type 1 diabetes, worsening with age.
- Microalbuminuria is a significant predictor of elevated nighttime blood pressure in diabetics.
- These findings highlight the importance of monitoring blood pressure and kidney function in type 1 diabetes management.
Abstract:
This study was designed to examine the circadian pattern of blood pressure in children and young adults with type I diabetes who were completely normotensive by standard criteria. Forty-five patients and the same number of age- and sex-matched control subjects were studied. In diabetic children of 10-14 years of age, the nocturnal fall in systolic and diastolic blood pressures was intact. In diabetics of 15-20 years of age, the fall in systolic blood pressure was blunted; in diabetics of 21-37 years of age, the fall in both systolic and diastolic blood pressures during sleep was blunted. When data from all diabetic subjects were pooled and analyzed in a multiple linear regression model, mean blood pressure during sleep correlated best with urinary albumin excretion (r = 0.60). On the basis of this finding, we subdivided our patients into two groups: a microalbuminuric group (urinary albumin excretion > 30 mg per 24 hours; mean, 160.3 +/- 29.7; n = 11) and a normoalbuminuric group (urinary albumin excretion < 30 mg per 24 hours; mean, 6.6 +/- 6.5; n = 34). Both systolic and diastolic blood pressures during sleep were higher in microalbuminuric (121.1 +/- 3.3 and 69.3 +/- 2.5 mm Hg, respectively) than in normoalbuminuric diabetics (114.2 +/- 1.8 and 60.1 +/- 1.2 mm Hg, p < 0.05) or control subjects (113.3 +/- 1.2 and 60.1 +/- 1.2 mm Hg, p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)