High prevalence of hypertension in children and adolescents with type 1 diabetes identified through the 24 hours ambulatory blood pressure monitoring

Objectives: In children and adolescents with type 1 diabetes (T1DM) the usefulness of 24-hours ambulatory blood pressure monitoring (ABPM) to predict kidney diseases and cardiovascular morbidity is still controversial. Aim of this study was to identify blood pressure abnormalities using both traditional clinic and 24 h-ABPM tools and their relationship with anthropometric, kidney, and metabolic data. Methods: Forty patients (52.5% males) with T1DM (age = 13.6 2.56 yrs; T1DM duration >1 yr) were recruited in the study. Anthropometric, metabolic (HbA1c, lipid profile, renal function parameters), and blood pressure (clinic visit and 24 h-ABPM) data were collected. Hypertension was defined as: A) systolic blood pressure (SBP) above 95 centile according to age, gender, and height centile, and B) SBP above 95 centile in more than 25% of 24 h-ABPM. Results: Hypertension was found in 9 out of 40 patients (22.5%) using data by clinic visit while through 24 h-ABPM its prevalence significantly increased to 57.5% (χ2 = 8.58, p = 0.003). Subjects with hypertension, according to 24 h-ABPM, had a longer duration of T1DM than normotensive ones (8.04 3.22 vs. 5.76 1.85 yrs, respectively, p = 0.013). Six out of 40 patients did not present the phenomena of dipping (3/6 classified as hypertensive). Considering the whole population, a significant and positive correlation was demonstrated between 24 h-ABPM SBP and BMI-SDS (r = 0.38, p = 0.020) and clinic visit SBP (r = 0.42, p = 0.007). No other significant data was found. Conclusions: The 24-hours ABPM has allowed us to identify a higher prevalence of hypertension compared to that we found using SBP data from the clinic visit. Despite subjects with hypertension have had T1DM for longer time, our data did not support a relationship between SBP, metabolic control, lipid profile, and renal function. We can considered ABPM a useful tool to precociously identify these patients who may benefit from early therapeutic treatment to prevent disease progression.