1. 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