Abstract

Objective: Arterial hypertension is a key player in the development of diabetic complications. We used a nationwide database to study risk factors for abnormal 24-hour blood pressure (BP) regulation and microalbuminuria in children and adolescents with diabetes type 1.

Research design and methods: Ambulatory blood pressure monitoring (ABPM) was performed in 2105 children and adolescents from 195 pediatric diabetes centers in Germany and Austria. Individual LMS-SD scores were calculated for diurnal and nocturnal systolic (SBP), diastolic (DBP) and mean arterial BP (MAP) according to normalized values of a reference population of 949 healthy German children. The nocturnal BP reduction (dipping) was calculated for SBP as well as DBP.

Results: In diabetic children, particularly nocturnal BP was significantly elevated (SBP +0.51, DBP +0.58 and MAP +0.80 LMS-SDS) and dipping of SBP, DBP and MAP was significantly reduced (p<0.0001). Age, diabetes duration, gender, body mass index (BMI), HbA1c and insulin dose were related to altered blood pressure profiles; dipping, however, was only affected by age, female gender and HbA1c. The presence of microalbuminuria was associated with nocturnal diastolic BP (p<0.0001) and diastolic dipping (p<0.01).

Conclusions: Our observations revealed a clear link between the quality of metabolic control and altered BP regulation even in pediatric patients with short diabetes duration. Particularly, the nocturnal BP seems to contribute mainly to diabetic complications such as microalbuminuria.