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Arterial blood pressure changes in children and adolescents with insulin-dependent diabetes mellitus
M A Theochari1, G P Vyssoulis, P K Toutouzas
1Department of Pediatrics, Faculty of Nursing, University of Athens, P. and A. Kyriakou Children's Hospital, Greece.
Insights
Children with insulin-dependent diabetes mellitus show elevated blood pressure and blood pressure burden, indicating early hemodynamic changes. These findings suggest a higher risk for developing diabetic nephropathy and related complications.
Area of Science:
- Pediatrics
- Cardiology
- Endocrinology
Background:
- Diabetic nephropathy, a common complication of diabetes, can manifest in childhood.
- Hypertension is a significant risk factor for the development and progression of diabetic nephropathy.
- Early detection of hemodynamic changes in children with diabetes is crucial for timely intervention.
Purpose of the Study:
- To investigate 24-hour ambulatory blood pressure patterns in children with insulin-dependent diabetes mellitus.
- To compare blood pressure levels and blood pressure burden between diabetic children and healthy siblings.
- To identify potential early hemodynamic alterations in pediatric diabetes.
Main Methods:
- Ambulatory blood pressure monitoring was conducted over 24 hours for 63 children with insulin-dependent diabetes mellitus.
- Blood pressure data from diabetic children were compared with those of 54 healthy siblings.
- Blood pressure burden was calculated as the percentage of readings above the 95th percentile.
Main Results:
- Children with diabetes exhibited significantly higher 24-hour systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) compared to controls.
- Elevated daytime and nighttime blood pressures were observed in the diabetic group.
- Diabetic patients showed a substantially higher 24-hour SBP and DBP burden, as well as daytime SBP and DBP burden, indicating increased blood pressure variability.
Conclusions:
- Children with insulin-dependent diabetes mellitus experience elevated blood pressure and increased blood pressure burden, even in the absence of clinical complications.
- These findings suggest that significant hemodynamic changes occur early in the course of pediatric diabetes.
- Early identification and management of hypertension in children with diabetes are essential to prevent long-term complications like diabetic nephropathy.
Abstract:
Diabetic nephropathy may develop in childhood and is often related to hypertension. The 24-hour ambulatory blood pressures were measured in 63 children with insulin-dependent diabetes mellitus and were compared with those of 54 healthy siblings. The patients were without clinical complications. The 24-hour recording of their blood pressures revealed higher 24-hour systolic blood pressure (SBP) (115.8 +/- 8.2), 24-hour diastolic blood pressure (DBP) (67.5 +/- 4.6), 24-hour mean arterial pressure (MAP) (81.8 +/- 5.2) compared with control subjects: 24-hour SBP (112.7 +/- 6.7), 24-hour DBP (64.7 +/- 4.1), 24-hour MAP (78.9 +/- 4.5) (p = 0.03, p = 0.001, p = 0.002, respectively). Of the daytime blood pressures, SBP, DBP, MAP were also higher (117.7 +/- 8.7, 69.7 +/- 5.2, 83.8 +/- 5.8) compared with those of siblings (114.9 +/- 6.9, 67.3 +/- 4.3, 81.1 +/- 4.9) (p = 0.05, p = 0.009, p = 0.008, respectively). Of the nighttime blood pressures, SBP, DBP, MAP were higher in patients (108.7 +/- 8.9, 59.5 +/- 6.9, 74.6 +/- 6.9) compared with control subjects (104.8 +/- 7.0, 55.1 +/- 5.0, 70.5 +/- 5.1) (p = 0.01, p = 0.0002, p = 0.0006, respectively). Furthermore, the blood pressure burden was evaluated. Blood pressure burden was defined as the percentage of the increased blood pressure readings greater than the 95th percentile divided by the total number of recorded blood pressures during a corresponding period. Patients had a 43% higher 24-hour SBP burden (19.6 +/- 16.5) and a 50% higher 24-hour DBP burden (12.3 +/- 9.6) in relation to that of control subjects (13.7 +/- 12.8, 8.3 +/- 12.3) (p = 0.03, p = 0.009, respectively). The SBP burden (17.9 +/- 14.6) and DBP burden (11.5 +/- 9.2) of the day was approximately 50% higher in the patients in the relation to control subjects (11.9 +/- 11.1, 7.8 +/- 6.7) (p = 0.01, p = 0.01, respectively). Therefore it seems that hemodynamic changes may appear early in children with diabetes.