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Arterial Hypertension Determined by Ambulatory Blood Pressure Profiles

Contribution to microalbuminuria risk in a multicenter investigation in 2,105 children and adolescents with type 1 diabetes

  1. Axel Dost, MD12,
  2. Christoph Klinkert, MD3,
  3. Thomas Kapellen, MD4,
  4. Andreas Lemmer, MD5,
  5. Andrea Naeke, MD6,
  6. Matthias Grabert, PHD7,
  7. Joachim Kreuder, MD2,
  8. Reinhard W. Holl, MD7 and
  9. for the DPV Science Initiative
  1. 1Department of Pediatrics, Friedrich Schiller University of Jena, Jena, Germany
  2. 2Department of Pediatrics, Justus Liebig University Giessen, Giessen, Germany
  3. 3Pediatric Practice, Herford, Germany
  4. 4Department of Pediatrics, University of Leipzig, Leipzig, Germany
  5. 5Helios Children's Hospital, Erfurt, Germany
  6. 6Department of Pediatrics, University of Dresden, Dresden, Germany
  7. 7Department of Epidemiology, University of Ulm, Ulm, Germany
  1. Address correspondence and reprint requests to Dr. Axel Dost, Department of Pediatrics, Friedrich Schiller University Jena, Kochstrasse 2, D-07740 Jena, Germany. E-mail: axel.dost{at}med.uni-jena.de

Abstract

OBJECTIVE—Arterial hypertension is a key player in the development of diabetes complications. We used a nationwide database to study risk factors for abnormal 24-h blood pressure regulation and microalbuminuria in children and adolescents with type 1 diabetes.

RESEARCH DESIGN AND METHODS—Ambulatory blood pressure monitoring was performed in 2,105 children and adolescents from 195 pediatric diabetes centers in Germany and Austria. Individual least median squares (LMS)-SD scores were calculated for diurnal and nocturnal systolic (SBP), diastolic (DBP), and mean arterial (MAP) blood pressure according to normalized values of a reference population of 949 healthy German children. The nocturnal blood pressure reduction (dipping) was calculated for SBP as well as DBP.

RESULTS—In diabetic children, nocturnal blood pressure in particular was significantly elevated (SBP +0.51, DBP +0.58, MAP +0.80 LMS-SD) and dipping of SBP DBP, and MAP was significantly reduced (P < 0.0001). Age, diabetes duration, sex BMI, A1C, and insulin dose were related to altered blood pressure profiles; dipping, however, was only affected by age, female sex, and A1C. The presence of microalbuminuria was associated with nocturnal DBP (P < 0.0001) and diastolic dipping (P < 0.01).

CONCLUSIONS—Our observations revealed a clear link between the quality of metabolic control and altered blood pressure regulation even in pediatric patients with short diabetes duration. Nocturnal blood pressure in particular seems to mainly contribute to diabetes complications such as microalbuminuria.

Footnotes

  • Published ahead of print at http://care.diabetesjournals.org on 3 January 2008. DOI: 10.2337/dc07-0824.

    The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C Section 1734 solely to indicate this fact.

    • Accepted December 26, 2007.
    • Received April 27, 2007.
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This Article

  1. Published online before print January 3, 2008, doi: 10.2337/dc07-0824 Diabetes Care April 2008 vol. 31 no. 4 720-725
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