Early identification of subclinical alterations of blood pressure in adolescents with cardiovascular risk: type 1 diabetic patients versus overweight subjects.

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Early identification of subclinical alterations of blood pressure in adolescents with cardiovascular risk: type 1 diabetic patients versus overweight subjects. Valentina Giacchi¹§, Tiziana Timpanaro¹, Donatella Lo Presti², Stefano Passanisi¹, Carmine Mattia¹, Pasqua Betta¹, Chiara Grasso¹, Manuela Caruso², Pietro Sciacca³ ¹ Department of Pediatrics, AOU Policlinico-Vittorio Emanuele, Catania (IT) ² Pediatric Endocrinology, AOU Policlinico-Vittorio Emanuele, Catania (IT) ³ Pediatric Cardiology, AOU Policlinico-Vittorio Emanuele, Catania (IT) BACKGROUND AND AIM Adolescents with type 1 diabetes (T1DM) and obesity present higher cardiovascular risk and ambulatory blood pressure measurements (ABPM) can identify the non-dipper status, often the first sign of hypertension. The aim of our observational cross-sectional case-control study conducted in T1DM, overweight and healthy adolescents was to assess blood pressure (BP) parameters to identify subclinical cardiovascular risk. METHODS ABPM for 24 h 39 adolescents (26 male and 13 female) with T1DM followed in our Pediatric Department (Jan 2011 and Dec 2012). We compared the data of patients with those of overweight subjects and healthy controls. RESULTS Variables Diabetics Overweight subjects P value Healthy controls Age (years) (M±SD) 15.4±2.3 14.5±2.9 0.12 15.2±2.7 0.8 Sex M/F (%) 32/16 (66.7/33.3) 33/15 (67.8/31.2) 0.82 38/10 (79.1/20.9) 0.16 BMI (Kg/m²) 20.1±3.8 31.9±3.38 0.000 21.3±3.31 0.121 Diabetes duration (years) 8±3.2 - ns HbA1c (%) 7.9±1.06 4.9±0.35 4.7±0.42 Total cholesterol (mg/dL) 153.4±30.3 171.9±15.5 0.001 146.9±26.3 0.22 Albuminuria (mg/day) 3,5±7 Albuminuria (n° of patients) 13 (27 %) Table 1. Demographic and clinical characteristics of diabetic patients, overweight subjects and healthy controls Variables Diabetics Overweight subjects P value Healthy controls 24 h Systolic Blood Pressure (mmHg) (M±SD) 123.9±11 125.2±8 0.54 116.1±6.5 0.000 24 h Diastolic Blood Pressure (mmHg) (M±SD) 73.2±8.3 74.4±8.1 0.42 68.3±4.6 0.001 Day-time Systolic Blood Pressure (mmHg) (M±SD) 125±11.4 127.2±8.4 0.31 119.5±6.3 0.004 Night-time Systolic Blood Pressure (mmHg) (M±SD) 120.3±12.2 118.8±10.8 0.52 110.5±8.9 Day-time Diastolic Blood Pressure (mmHg) (M±SD) 75.7±9.9 76.9±9.1 0.47 72.3±5.5 0.039 Night-time Diastolic Blood Pressure (mmHg) (M±SD) 69.1±8.7 67.8±8.9 62.6±5.9 Dipper (n°) 8 (16.7 %) 18 (37.5%) 0.022 32 (66.7 %) Nondipper (n°) 40 (83.3 %) 33 (68.8 %) 0.094 16 (33.3 %) Blood Hypertension (n°) 12 (25 %) 10 (20.8 %) 0.62 Blood Hypertension + nondipper (n°) 4 (8.3 %) 3 (6.2 %) 0.69 0.041 Table 2. Blood pressure profiles of diabetic patients, overweight subjects and healthy controls CONCLUSIONS ABPM studies allows to identify patients at risk for the development of hypertension, who might benefit from the early introduction of anti-hypertensive therapies. In evaluating BP in T1DM and overweight subjects, ABPM should be used since a reduced dipping can indicate incipient hypertension. Pall D, Kiss I, Katona E. Importance of Ambulatory Blood Pressure Monitoring in Adolescent Hypertension. Kidney Blood Press Res 2012;35:129–134