Ambulatory blood pressure parameters and their association with albuminuria in adolescents with type 1 diabetes mellitus

Abstract

Background: This study aimed to evaluate the blood pressure (BP) status, including arterial stiffness parameters, hemodynamic indicators, circadian profile, and its association with albuminuria in adolescents with type 1 diabetes mellitus (DM1).

Methods: The analysis included 46 patients, with diabetes duration of 7.38 ± 3.48 years. Ambulatory blood pressure monitoring (ABPM) was conducted using an oscillometric device, the Mobil-O-Graph, which is a Pulse Wave Analysis Monitor.

Results: Hypertension (HT) was diagnosed in 31 adolescents (67% of patients), primarily due to isolated nocturnal BP (21 cases, 68% of HT cases). The HT group exhibited significantly increased diastolic load (DL). Pulse wave velocity (PWV, a measure of arterial stiffness) values showed a strong correlation with both peripheral systolic BP (r = 0.954) and central systolic BP (r = 0.838). Additionally, non-dipping status was found in 61% of the HT group. Urinary albumin excretion (UAE) was positively correlated with diastolic BP (particularly nocturnal) peripheral and central BP, DL, heart rate, augmentation index (AIx@75), and nocturnal total vascular resistance (TVR). Diastolic non-dippers exhibited a significant increase in UAE.

Conclusions: Hypertension is a common complication in adolescents with type 1 diabetes mellitus, primarily caused by elevated nocturnal diastolic BP. Albuminuria is mainly associated with diastolic BP, especially during the nocturnal period and in cases of diastolic non-dipping status. The association of UAE with AIx@75 and nocturnal TVR suggests the presence of early-stage vascular disease in diabetic adolescents.

Keywords: Albuminuria; Ambulatory blood pressure monitoring; Diabetes mellitus; Diabetic kidney disease; Hypertension; Pediatrics; Vascular disease.

A higher resolution version of the Graphical abstract is available as Supplementary information

Fig. 1

The flow diagram of the study methodology

Fig. 2

a The comparison of pulse wave velocity (PWV) between subgroups according to blood pressure; b the comparison of cardiac output (CO) between subgroups according to blood pressure; c the comparison of diastolic load (DL) between subgroups according to blood pressure; d the comparison of urinary albumin excretion (UAE) between diastolic non-dippers (nd) and dippers (d); C, control group; N, normotensive patients; HT, hypertensive patients

Fig. 3

a The correlation between urinary albumin excretion (UAE) and a 24-h augmentation index (Aix@75); b the correlation between UAE and nocturnal total vascular resistant (TVR)