Implications of Nocturnal Hypertension in Children and Adolescents With Type 1 Diabetes

Abstract

OBJECTIVEDiabetes is associated with atherogenic risk factors. Hypertension has a major influence on cardiovascular disease in diabetic patients. Ambulatory blood pressure monitoring (ABPM) is useful for identifying nocturnal hypertension. Carotid intima-media thickness (cIMT) is a good measure for identifying subclinical atherosclerosis. This study aimed to evaluate whether nocturnal hypertension affects atherosclerosis in children and adolescents with type 1 diabetes and to investigate the relationship between atherogenic risk factors and cIMT.RESEARCH DESIGN AND METHODSABPM and cIMT were measured in 82 diabetic children and adolescents. We reviewed the hemoglobin A1c levels, 24-h urine microalbumin excretion, lipid profiles, and duration of diabetes. Nocturnal hypertension was defined as hypertension observed only at night.RESULTSForty-three (52%) subjects were hypertensive, and 30 subjects were classified as having nocturnal hypertension. cIMT was higher in the nocturnal hypertensive group than in the normotensive group (0.44 ± 0.03 vs. 0.42 ± 0.04 mm, P = 0.026). Among children and adolescents with nonhypertensive blood pressure levels in clinic blood pressure monitoring, cIMT and daytime blood pressure were higher in the nocturnal hypertensive group. All ABPM parameters were significantly related to cIMT in multiple linear regression analysis.CONCLUSIONSThis study showed significantly increased cIMT and daytime blood pressure in diabetic children and adolescents with nocturnal hypertension. ABPM may be a useful method for detecting the macrovascular complications of type 1 diabetes. Longitudinal studies are needed to find the causes of nocturnal hypertension and to evaluate the effect of nocturnal hypertension on atherosclerosis in type 1 diabetes.

Update: Ambulatory Blood Pressure Monitoring in Children and Adolescents

“…Pediatric patients with casual prehypertension may demonstrate abnormalities on ABPM intermediate between normotensive and truly hypertensive people, 78 and some studies have demonstrated subtle signs of target-organ damage in patients with prehypertension, including LVM values similar to youths with sustained hypertension, 34 lower glomerular filtration rate, and increased urine protein excretion, 79 as well as higher cIMT than normotensive patients. 80 Patients with prehypertension may also be at higher risk of progressing to sustained hypertension. 12 Although no longitudinal ABPM studies have been performed to evaluate the risk of progression of prehypertension, such studies could clarify the importance of prehypertension by providing more careful phenotyping of the BP patterns that produce the highest risk of progression to sustained hypertension.…”

Abnormalities of vascular structure and function in pediatric hypertension

“…Lande et al [20], found that IMT correlated with higher daytime SBP index (measured with ambulatory BP monitoring) which indicates more severe HTN. Other investigators have related 24-hour ambulatory BP monitoring measures to IMT, including a study of youth with type 1 diabetes mellitus where adolescents with reduced nocturnal BP dipping were found to have a thicker IMT [21]. Children with chronic kidney disease (CKD) have also been found to have a thicker cIMT than age-matched controls [22].…”

Increased carotid intima–media thickness (CIMT) levels in patients with type 1 diabetes mellitus (T1DM): A meta-analysis

“…And cardiovascular disease is based on atherosclerosis (AS), the hallmark of cardiovascular diseases, which is the leading cause of mortality all over the world. Many studies reported that patients with diabetes have 2 to 10 times increased risk of developing atherosclerotic disease (Atabek, Akyürek, Eklioglu, & Alp, 2014;Lee et al, 2011;Pozza, Netz, Schwarz, & Bechtold, 2010;Tantawy, Adly, El Maaty, & Amin, 2009). Carotid intima-media thickness (CIMT) level is the symbol of early atherosclerosis, it has been shown to be the marker of preclinical atherosclerosis (Gimenez et al, 2010), and measurement of the CIMT is independently associated with an increased cardiovascular disease (Atabek, Pirgon, Kurtoglu, & Imamoglu, 2006).…”