Isabel Mateo-Gavira1, Francisco J Vílchez-López2, María V García-Palacios3, Florentino Carral-San Laureano4, Soledad Jiménez-Carmona5, Manuel Aguilar-Diosdado6. 1. Department of Endocrinology, Puerta del Mar Hospital, Cadiz, Spain. Electronic address: isamateogavira@gmail.com. 2. Department of Endocrinology, Puerta del Mar Hospital, Cadiz, Spain. Electronic address: franvilchez1977@gmail.com. 3. Department of Preventive Medicine and Public Health, Puerta del Mar Hospital, Cádiz, Spain. Electronic address: jaspitaxx@hotmail.com. 4. Department of Endocrinology, Puerto Real Hospital, Cádiz, Spain. Electronic address: florencarral@hotmail.com. 5. Department of Ophthalmology, Puerta del Mar Hospital, Cádiz, Spain. Electronic address: soledad.jimenez@uca.es. 6. Department of Endocrinology and Investigation Unit, Puerta del Mar Hospital, Cádiz, Spain. Electronic address: manuelaguilardiosdado.sspa@juntadeandalucia.es.
Abstract
AIMS: To evaluate relationships between early alterations in blood pressure and the progression of microvascular complications of diabetes in clinically-normotensive patients with type 1 diabetes (T1DM). METHODS: In a prospective observational study of 85 normotensive T1DM patients without microalbuminuria, blood pressure (BP) was monitored over 24h using the ambulatory blood pressure monitoring (ABPM) system at baseline and 7years later. Development or progression of microalbuminuria, retinopathy and hypertension was evaluated. RESULTS: Initially, 20 patients (24%) were diagnosed with masked hypertension and 31 (37%) with non-dipper pattern as the only pathological findings. At 7years: 1) twenty-seven patients (32%) had progression of retinopathy related to the nocturnal diastolic blood pressure (BPD) (OR:1.122; p=0.034) and final non-dipper pattern (OR:5.857; p=0.005); 2) seven patients (10%) developed microalbuminuria for which nocturnal systolic blood pressure (BPS) was a risk factor (OR:1.129; p=0.007); 3) five of the normotensive patients (9%) progressed to hypertension; historic HbA1c (OR:2.767; p=0.046) and nocturnal BPD (OR:1.243; p=0.046) being the related risk factors. BPD level ≥65mmHg was associated with an increase in progression of retinopathy and hypertension. CONCLUSIONS: In T1DM patients there is an elevated prevalence of BP alterations, detected using ABPM. Alterations in nocturnal BP predispose to development/progression of microvascular complications and overt hypertension.
AIMS: To evaluate relationships between early alterations in blood pressure and the progression of microvascular complications of diabetes in clinically-normotensive patients with type 1 diabetes (T1DM). METHODS: In a prospective observational study of 85 normotensive T1DM patients without microalbuminuria, blood pressure (BP) was monitored over 24h using the ambulatory blood pressure monitoring (ABPM) system at baseline and 7years later. Development or progression of microalbuminuria, retinopathy and hypertension was evaluated. RESULTS: Initially, 20 patients (24%) were diagnosed with masked hypertension and 31 (37%) with non-dipper pattern as the only pathological findings. At 7years: 1) twenty-seven patients (32%) had progression of retinopathy related to the nocturnal diastolic blood pressure (BPD) (OR:1.122; p=0.034) and final non-dipper pattern (OR:5.857; p=0.005); 2) seven patients (10%) developed microalbuminuria for which nocturnal systolic blood pressure (BPS) was a risk factor (OR:1.129; p=0.007); 3) five of the normotensive patients (9%) progressed to hypertension; historic HbA1c (OR:2.767; p=0.046) and nocturnal BPD (OR:1.243; p=0.046) being the related risk factors. BPD level ≥65mmHg was associated with an increase in progression of retinopathy and hypertension. CONCLUSIONS: In T1DM patients there is an elevated prevalence of BP alterations, detected using ABPM. Alterations in nocturnal BP predispose to development/progression of microvascular complications and overt hypertension.