Ann Pediatr Endocrinol Metab.  2022 Mar;27(1):44-51. 10.6065/apem.2142084.042.

Effects of circadian blood pressure patterns on development of microvascular complications in pediatric patients with type 1 diabetes mellitus

Affiliations
  • 1Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea

Abstract

Purpose
The effects of circadian blood pressure (BP) alterations on the development and progression of microvascular complications in type 1 diabetes mellitus (T1DM) patients are unknown. We evaluated the effects of circadian BP alterations with development of microvascular complications during follow-up with patients with childhood-onset T1DM.
Methods
We investigated the medical records of 81 pediatric patients with T1DM who underwent 24-hour ambulatory BP monitoring (ABPM) between January 2009 and February 2010.
Results
Mean age at diagnosis and ABPM evaluation was 8.0±3.9 and 15.6±2.4 years, respectively. Hypertension (daytime, nighttime, and 24-hour mean hypertension) data were available in 42 patients. During the 8 years of follow-up after ABPM, microvascular complications occurred in 8 patients (diabetic retinopathy [DR] alone in 5, microalbuminuria alone in 2, and both in 1), of whom 7 had nondipper BP. Nighttime diastolic BP, nighttime mean arterial pressure, and glycated hemoglobin A (HbA1c) level were higher in patients with DR than in those without DR (P<0.05 for all). Daytime or nighttime BP and presence of dipper BP were not related to microvascular complications, but diabetic microvascular complications were more likely to occur in patients with an older age at diagnosis and higher HbA1c level. The proportion of patients with DR was higher in those with nondipper hypertension (83.3%) compared with dipper and nondipper normotension (0% and 16.7%, respectively; P=0.021).
Conclusion
As a predictor of microvascular complications, nondipper hypertension was not significant. Glycemic control rather than nondipper hypertension is the predominant factor determining DR in T1DM patients.

Keyword

Type 1 diabetes mellitus; Blood pressure monitoring; Ambulatory; Hypertension

Figure

  • Fig. 1. Kaplan-Meier survival curves. Cumulative probabilities of total microvascular complications (microalbuminuria and diabetic retinopathy) (P=0.105) (A), diabetic retinopathy (P=0.038) (B), and microalbuminuria (P=0.85) (C) according to type 1 diabetes mellitus duration. Over the 8-year follow-up after ambulatory blood pressure (BP) monitoring evaluation, microvascular complications occurred in 8 patients (diabetic retinopathy alone in 5, microalbuminuria alone in 2, and both in 1), of whom 7 had nondipper BP. NHTN, normotension.


Reference

References

1. Chillaron JJ, Flores Le-Roux JA, Benaiges D, Pedro-Botet J. Type 1 diabetes, metabolic syndrome and cardiovascular risk. Metabolism. 2014; 63:181–7.
2. Marcovecchio ML, Dalton RN, Schwarze CP, Prevost AT, Neil HA, Acerini CL, et al. Ambulatory blood pressure measurements are related to albumin excretion and are predictive for risk of microalbuminuria in young people with type 1 diabetes. Diabetologia. 2009; 52:1173–81.
3. Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics. 2017; 140:e20171904.
4. Dost A, Bechtold-Dalla Pozza S, Bollow E, Kovacic R, Vogel P, Feldhahn L, et al. Blood pressure regulation determined by ambulatory blood pressure profiles in children and adolescents with type 1 diabetes mellitus: Impact on diabetic complications. Pediatr Diabetes. 2017; 18:874–82.
5. Lee SH, Kim JH, Kang MJ, Lee YA, Won Yang S, Shin CH. Implications of nocturnal hypertension in children and adolescents with type 1 diabetes. Diabetes Care. 2011; 34:2180–5.
6. Flynn JT, Daniels SR, Hayman LL, Maahs DM, McCrindle BW, Mitsnefes M, et al. Update: ambulator y blood pressure monitoring in children and adolescents: a scientific statement from the American Heart Association. Hypertension. 2014; 63:1116–35.
7. Kim JH, Yun S, Hwang SS, Shim JO, Chae HW, Lee YJ, et al. The 2017 Korean National Growth Charts for children and adolescents: development, improvement, and prospects. Korean J Pediatr. 2018; 61:135–49.
8. Wuhl E, Witte K, Soergel M, Mehls O, Schaefer F; German Working Group on Pediatric H. Distribution of 24-h ambulator y blood pressure in children: normalized reference values and role of body dimensions. J Hypertens. 2002; 20:1995–2007.
9. Katsarou A, Gudbjornsdottir S, Rawshani A, Dabelea D, Bonifacio E, Anderson BJ, et al. Type 1 diabetes mellitus. Nat Rev Dis Primers. 2017; 3:17016.
10. Brink SJ. Complications of pediatric and adolescent type 1 diabetes mellitus. Curr Diab Rep. 2001; 1:47–55.
11. Ayer JG, Harmer JA, Nakhla S, Xuan W, Ng MK, Raitakari OT, et al. HDL-cholesterol, blood pressure, and asymmetric dimethylarginine are significantly associated with arterial wall thickness in children. Arterioscler Thromb Vasc Biol. 2009; 29:943–9.
12. Urbina EM, Kimball TR, McCoy CE, Khoury PR, Daniels SR, Dolan LM. Youth with obesity and obesity-related type 2 diabetes mellitus demonstrate abnormalities in carotid structure and function. Circulation. 2009; 119:2913–9.
13. Lurbe E, Torro I, Alvarez V, Nawrot T, Paya R, Redon J, et al. Prevalence, persistence, and clinical significance of masked hypertension in youth. Hypertension. 2005; 45:493–8.
14. Stabouli S, Kotsis V, Toumanidis S, Papamichael C, Constantopoulos A, Zakopoulos N. White-coat and masked hypertension in children: association with target-organ damage. Pediatr Nephrol. 2005; 20:1151–5.
15. Sulakova T, Janda J, Cerna J, Janstova V, Sulakova A, Slany J, et al. Arterial HTN in children with T1DM--frequent and not easy to diagnose. Pediatr Diabetes. 2009; 10:441–8.
16. Donaghue KC, Marcovecchio ML, Wadwa RP, Chew EY, Wong TY, Calliari LE, et al. ISPAD Clinical Practice Consensus Guidelines 2018: Microvascular and macrovascular complications in children and adolescents. Pediatr Diabetes. 2018; 19 Suppl 27:262–74.
17. Amin R, Widmer B, Prevost AT, Schwarze P, Cooper J, Edge J, et al. Risk of microalbuminuria and progression to macroalbuminuria in a cohort with childhood onset type 1 diabetes: prospective observational study. BMJ. 2008; 336:697–701.
18. Kwon AR, Lee S, Chae HW, Kim DH, Kim HS. Frequencies and related factors for microvascular complications in patients with type 1 diabetes. Ann Pediatr Endocrinol Metab. 2012; 17:16–26.
19. Khalil H. Diabetes microvascular complications-A clinical update. Diabetes Metab Syndr. 2017; 11 Suppl 1:S133–9.
20. Ng SM, Ayoola OO, McGuigan MP, Chandrasekaran S. A multicentre study evaluating the risk and prevalence of diabetic retinopathy in children and young people with type 1 diabetes mellitus. Diabetes Metab Syndr. 2019; 13:744–6.
21. Kim JH. Current status of continuous glucose monitoring among Korean children and adolescents with type 1 diabetes mellitus. Ann Pediatr Endocrinol Metab. 2020; 25:145–51.
22. Cuspidi C, Sala C, Tadic M, Gherbesi E, De Giorgi A, Grassi G, et al. Clinical and prognostic significance of a reverse dipping pattern on ambulatory monitoring: an updated review. J Clin Hypertens (Greenwich). 2017; 19:713–21.
23. Kilic A, Baydar O. The relationship between diurnal blood pressure abnormalities and target organ damage in normotensive subjects. Which is more important? Increased blood pressure levels or circadian blood pressure abnormalities. Clin Exp Hypertens. 2020; 42:244–9.
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