Objectives: To evaluate the prevalence of subclinical hypertension detected by ambulatory blood pressure monitoring (ABPM) and its relationship with some clinical and epidemiological factors in normotensive and normoalbuminuric patients with type 1 diabetes.
Patients and methods: Transversal study that included patients with type 1 diabetes, older than 18 years, with clinic blood pressure lower than 130/80 mmHg and absence of microalbuminuria. Twenty-four hours blood pressure monitoring was performed (SPACELABS 90217). We considered normal ABPM those with mean systolic and diastolic blood pressure (sBP and dBP) over 24 h and daytime lower than 130/80 mmHg and over night-time lower than 120/70 mmHg. Subjects with a nocturnal fall in either sBP or dBP of less than 10% of daytime values were classified as non-dippers.
Results: Eighty-five type 1 diabetic patients (55% women) aged 27.9±6.1 years, with a disease duration of 12.3±6.5 years. Mean HbA1c since diagnosis was 8.3±1.4%. In 32% of patients (n=27), mean sBP or dBP was altered over daytime and 41.6% of them (n=36) were non-dippers. Blood pressure burden was more prevalent in men. BMI was higher in patients with mean sBP elevated over daytime (26.4±3.4 vs 23.5±2.7 kg/m2, P: 0.002). Non-dippers showed worse metabolic control since diagnosis (HbA1c 8.6±1.4% vs 7.9±1.4%; P=0.046). HDL-cholesterol level was lower and triglycerides level higher in subjects with altered sBP or dBP over daytime (HDLc: 55.9±14.4 vs 66.8±13.8 mg/dl, P: 0.003; TG: 97.9±52.5 vs 65.7±13.5 mg/dl, P: 0.003).
Conclusions: (1) Normoalbuminuric and normotensive type 1 diabetic patients present high prevalence of subclinical alterations of blood pressure so ABPM is appropriate to detect them. (2) Burden BP was more frequent in men, in patients with elevated BMI, with worse metabolic control and lipid profile. Association of altered ABMP and classical cardiovascular risk factors suggests that cardiovascular risk factors should be treated soon and intensively, as in type 2 diabetes.
03 - 07 May 2008
European Society of Endocrinology