Assessment of arterial stiffness from ambulatory blood pressure monitoring in children with diabetes mellitus type-1 (DMT1)

Abstract

Pulse pressure (PP) and ambulatory arterial stiffness index (AASI) can be calculated from ambulatory blood pressure (BP) monitoring (ABPM) and have been suggested as markers of arterial stiffness and predictors of cardiovascular mortality. We retrospectively evaluated PP and AASI from ABPM records in 84 children (43 boys) with diabetes mellitus type-1 (DMT1) compared with 27 non-diabetic normotensive children. Based on office BP and ABPM, patients with DMT1 were divided into three groups: 24/84 (29%) had hypertension (DM HTN), 33/84 (39%) were normotensive (DM NT) and 27/84 (32%) had white-coat hypertension (DM WCH). DM WCH and DM HTN patients had significantly higher PP when compared with DM NT and NT patients alone (47.62 ± 7.31 and 47.43 ± 8.68 versus 41.45 ± 4.44 and 42.18±5.97, respectively, P ¼ 0.0002). Similarly, AASI was significantly elevated in both DM WCH and DM HTN patients when compared with NT patients (0.35 ± 0.14 and 0.36 ± 0.15 versus 0.23 ± 0.15, respectively, P ¼ 0.007). In conclusion, children with DMT1 and hypertension, including WCH, had significantly higher PP and AASI levels when compared with normotensive patients. This suggests that these children may be at an increased risk for developing cardiovascular complications later on in life.

Update: Ambulatory Blood Pressure Monitoring in Children and Adolescents

“…This has been replicated in youths with type 1 diabetes mellitus and hypertension. 55 Using direct measurements, when BP was evaluated with ABPM, youths categorized as either prehypertensive or truly hypertensive had increased pulse-wave velocity compared with normotensive subjects. 56 In obese youths, higher ABPM (but not casual BP) was found to be associated with higher carotid stiffness and reduced endothelial function.…”

Abnormalities of vascular structure and function in pediatric hypertension

“…Regardless, utility of the parameter is suggested by observations that AASI is elevated in children and young adults with primary HTN and secondary to repaired coarctation of the aorta [49]. AASI was also elevated in children with type 1 diabetes mellitus and concomitant hypertension as compared to healthy controls or non-hypertensive diabetic youth [50]. …”

Elevated glycated hemoglobin levels impair blood pressure in children and adolescents with type 1 diabetes mellitus

“…Furthermore, children with T1DM and hypertension present higher pulse pressure and ambulatory stiffness index levels when compared with normotensive patients [1]. Elevated values of blood pressure (BP) in children with T1DM are associated with an increased risk for developing cardiovascular complications later in life [1].…”

“…Furthermore, children with T1DM and hypertension present higher pulse pressure and ambulatory stiffness index levels when compared with normotensive patients [1]. Elevated values of blood pressure (BP) in children with T1DM are associated with an increased risk for developing cardiovascular complications later in life [1]. Consequently, the early assessment of hypertension, diagnosis, management and treatment is critical in reducing long term microvascular and macrovascular complications [2].…”