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Diabetes Care 24:1624-1628, 2001
© 2001 by the American Diabetes Association, Inc.

Pathophysiology/Complications
Original Article

Variations of Ambulatory Blood Pressure With Position in Patients With Type 1 Diabetes

Influence of disease duration and microangiopathy in a pilot study

Pierre Y. Benhamou, MD, PHD1, Sandrine Mouret, MD2, Jean L. Quesada, PHD2, Robert Boizel, MD1, Jean P. Baguet, MD2, Serge Halimi, MD1 and Jean M. Mallion, MD2

1 Department of Endocrinology, Grenoble University Hospital, Grenoble, and the
2 Department of Internal Medicine and Cardiology, Grenoble University Hospital, Grenoble, France

OBJECTIVE—To study the influence of position changes on 24-h ambulatory blood pressure (ABP) in normotensive or mildly hypertensive normoalbuminuric patients with type 1 diabetes.

RESEARCH DESIGN AND METHODS—A cross-sectional evaluation of patients was staged according to the duration of diabetes (DD) and the presence of microangiopathy. We recruited 37 patients (30 men and 7 women), aged 38 ± 12 years, who were normotensive or mildly hypertensive (diastolic blood pressure [DBP] <105 mmHg) and free of antihypertensive treatment and microalbuminuria. They were included according to DD (group 1, <5 years; group 2, >=10 years). An additional group of seven diabetic patients with microalbuminuria and mild untreated hypertension was also investigated. We recorded 24-h ambulatory blood pressure every 15 min with a position sensor, which allowed for the discrimination between standing or supine/sitting position in the patient.

RESULTS—Mean daytime (10:00 A.M. to 8:00 P.M.) ABP in supine/sitting position did not significantly differ between groups 1 and 2. However, standing ambulatory systolic blood pressure (ASBP) and ambulatory DBP (ADBP) were significantly higher than supine/sitting ASBP and ADBP in group 1 ({Delta}SBP 4 ± 5, {Delta}DPB 4 ± 6 mmHg, P < 0.01) but not in group 2 ({Delta}SBP 2 ± 8, {Delta}DBP 2 ± 4 mmHg, P = NS). Patients free of microangiopathy presented with significantly higher ABP in standing position than in sitting/lying position, whereas patients with retinopathy and/or nephropathy exhibited no significant increase of ABP during standing.

CONCLUSION—The monitoring of position during ambulatory measurement of blood pressure in type 1 diabetic patients shows different patterns in relation to disease duration and the presence of microangiopathy.

Abbreviations: ABP, ambulatory blood pressure • ABPM, ambulatory blood pressure management • ADBP, ambulatory diastolic blood pressure • AHR, ambulatory heart rate • ANOVA, analysis of variance • ASBP, ambulatory systolic blood pressure • BP, blood pressure • DBP, diastolic BP • DD, duration of diabetes • HR, heart rate • SBP, systolic BP • UAE, urinary albumin excretion • VH, vertical/horizontal • WHO, World Health Organization


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Copyright © 2001 by the American Diabetes Association.