A Dost1, S Bechtold-Dalla Pozza2, E Bollow3,4, R Kovacic5, P Vogel6, L Feldhahn7, K O Schwab8, R W Holl3,4. 1. Department of Pediatric Endocrinology and Diabetes, University Hospital Jena, Jena, Germany. 2. Department of Pediatric Endocrinology and Diabetology, University Hospital Munich, Munich, Germany. 3. Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany. 4. German Center for Diabetes Research (DZD), Neu-Herberg, Germany. 5. Pediatric Diabetes Center, Debant, Austria. 6. Department of Pediatrics, Departments of Pediatrics, Garmisch-Partenkirchen, Germany. 7. Hospital Böblingen, Boeblingen, Germany. 8. Department of Pediatrics, University Hospital, Freiburg, Germany.
Abstract
BACKGROUND: The combination of high blood pressure and hyperglycemia contributes to the development of diabetic complications. Ambulatory monitoring of blood pressure (ABPM) is seen as standard to assess blood pressure (BP) regulation. OBJECTIVE: We evaluated 24-hour BP regulation in 3529 children with type 1 diabetes, representing 5.6% of the patients <20 years of age documented in the DPV registry, and studied the influence of BP parameters including pulse pressure (PP) and blood pressure variability (BPV) on microalbuminuria (MA) and diabetic retinopathy (DR). RESULTS: BP was increased in this selected cohort of children with diabetes compared to healthy German controls (standard deviation score (SDS) day: systolic BP (SBP) +0.06, mean arterial pressure (MAP) +0.08, PP +0.3; night: SBP +0.6, diastolic BP +0.6, MAP +0.8), while daytime diastolic BP (SDS -0.2) and dipping of SBP and MAP were reduced (SBP -1.1 SDS, MAP 12.4% vs 19.4%), PP showed reverse dipping (-0.7 SDS). Children with microvascular complications had by +0.1 to +0.75 SDS higher BP parameters, except of nocturnal PP in MA and diurnal and nocturnal PP in DR. Reverse dipping of PP was more pronounced in the children with MA (-5.1% vs -0.8%) and DR (-2.6% vs -1.0%). BP alteration was stronger in girls and increased with age. CONCLUSION: There is an early and close link between 24-hour blood pressure regulation and the development of diabetic complications not only for systolic, diastolic, and mean arterial BP but also for the derived BP parameter PP and BPV in our selected patients.
BACKGROUND: The combination of high blood pressure and hyperglycemia contributes to the development of diabetic complications. Ambulatory monitoring of blood pressure (ABPM) is seen as standard to assess blood pressure (BP) regulation. OBJECTIVE: We evaluated 24-hour BP regulation in 3529 children with type 1 diabetes, representing 5.6% of the patients <20 years of age documented in the DPV registry, and studied the influence of BP parameters including pulse pressure (PP) and blood pressure variability (BPV) on microalbuminuria (MA) and diabetic retinopathy (DR). RESULTS: BP was increased in this selected cohort of children with diabetes compared to healthy German controls (standard deviation score (SDS) day: systolic BP (SBP) +0.06, mean arterial pressure (MAP) +0.08, PP +0.3; night: SBP +0.6, diastolic BP +0.6, MAP +0.8), while daytime diastolic BP (SDS -0.2) and dipping of SBP and MAP were reduced (SBP -1.1 SDS, MAP 12.4% vs 19.4%), PP showed reverse dipping (-0.7 SDS). Children with microvascular complications had by +0.1 to +0.75 SDS higher BP parameters, except of nocturnal PP in MA and diurnal and nocturnal PP in DR. Reverse dipping of PP was more pronounced in the children with MA (-5.1% vs -0.8%) and DR (-2.6% vs -1.0%). BP alteration was stronger in girls and increased with age. CONCLUSION: There is an early and close link between 24-hour blood pressure regulation and the development of diabetic complications not only for systolic, diastolic, and mean arterial BP but also for the derived BP parameter PP and BPV in our selected patients.
Authors: Katrin Nagl; Esther Bollow; Susanne Liptay; Joachim Rosenbauer; Sibylle Koletzko; Angeliki Pappa; Andrea Näke; Elke Fröhlich-Reiterer; Christian Döring; Johannes Wolf; Peter Salfeld; Nicole Prinz Journal: Pediatr Diabetes Date: 2019-08-26 Impact factor: 4.866
Authors: Anna Vágvölgyi; Ágnes Maróti; Mónika Szűcs; Csongor Póczik; Dóra Urbán-Pap; István Baczkó; Attila Nemes; Éva Csajbók; Krisztián Sepp; Péter Kempler; Andrea Orosz; Tamás Várkonyi; Csaba Lengyel Journal: Front Endocrinol (Lausanne) Date: 2021-08-27 Impact factor: 5.555