RESEARCH PAPER
 Effect of arterial hypertension on renal lesions in children with type 1 diabetes
 
More details
Hide details
1
Klinika Kardiologii i Nefrologii Dziecięcej, Szpital Kliniczny Uniwersytetu Medycznego w Poznaniu
2
Klinika Diabetologii i Otyłości Wieku Rozwojowego, Szpital Kliniczny Uniwersytetu Medycznego w Poznaniu
CORRESPONDING AUTHOR
Jolanta Sołtysiak
Klinika Kardiologii i Nefrologii, Szpital Kliniczny im. K. Jonschera Uniwersytetu Medycznego w Poznaniu, ul. Szpitalna 27/33, 60-572 Poznań
 
Med Og Nauk Zdr. 2013;19(1):55–58
KEYWORDS
ABSTRACT
Introduction:
Arterial hypertension (AH), one of the complications of type 1 diabetes (T1DM) is a risk factor of the development of diabetic nephropathy. Evaluation of arterial hypertension in children with T1DM based on 24-hour monitoring (ABPM), and the relationship between ABPM parameters and albuminuria (ACR) and risk factors of diabetic nephropathy, i.e. glycosylated hemoglobin (HbA1c), duration of diabetes, total cholesterol (Chol), and triglycerides (TG).

Material and Methods:
The study covered 107 children (53 girls and 54 boys) with T1DM; mean age 14.22±2.90; mean duration of the disease T1DM 5.81±3.62 years. The measurements were performed by ABPM using the oscillometric method. The values of the systolic blood pressure were analysed during the day (SBPD) and at night (SBPN), diastolic pressure during the day (DBPD) and night (DBPN), and night decrease of the arterial pressure. AH was diagnosed in more than 95% of patients, prehypertension (preAH) – in more than 90%, and normal blood pressure (nBP) in less than 90%

Results:
AH was observed in 25.3% of children, preHA – in 22.4%, and nBP – in 52.3%. Children with AH were significantly older statistically, compared to those with nBP, with longer duration of the disease and higher BMI, HbA1c, ACR and TG values. A positive relationship was observed between arterial hypertension and duration of T1DM, BMI, ACR and TG. A lack of night decrease of the arterial pressure was found in 34% of children. These children, compared to patients with maintained daily pressure profile, did not differ with respect to the BMI, HbA1c, ACR, Chol and TG.

Conclusions:
Arterial hypertension more frequently occurs in children with T1DM, compared to the total populaiton. The risk of renal lesions in T1DM significantly increases in children with AH, and is related with the value of arterial blood pressure.

 
REFERENCES (19)
1.
Sowers JR, Epstein M, Frohlich ED. Diabetes, hypertension, and cardiovascular disease: an update. Hypertension 2001; 37: 1053.
 
2.
Antczak, Myśliwiec, Pruszczyk. Wielka Interna. Nefrologia. Czekalski S, Myśliwiec M (red). Cukrzycowa choroba nerek. Warszawa: Medical Tribune Polska 2010; 180-197.
 
3.
Urbina E, Alpert B, Flynn J, Hayman L, Harshfield GA, Jacobson M, i wsp. Ambulatory blood pressure monitoring in children and adolescents: recommendations for standard assessment: a scientific statement from the American Heart Association Atherosclerosis, Hypertension, and Obesity in Youth Committee of the council on cardiovascular disease in the young and the council for high blood pressure research. Hypertension 2008; 52: 433-451.
 
4.
Holl RW, Pavlovic M, Heinze E, Thon A. Circadian blood pressure during the early course of type 1 diabetes. Analysis of 1,011 ambulatory blood pressure recordings in 354 adolescents and young adults. Diabetes Care. 1999; 22(7): 1151-1157.
 
5.
Lurbe E, Redon J, Kesani A, Pascual JM, Tacons J, Alvarez V i wsp. Increase in nocturnal blood pressure and progression to microalbuminuria in type 1 diabetes. N Engl J Med. 2002; 347(11): 797.
 
6.
Torbjörnsdotter TB, Jaremko GA, Berg UB. Nondipping and its relation to glomerulopathy and hyperfiltration in adolescents with type 1 diabetes. Diabetes Care. 2004; 27(2): 510-516.
 
7.
K/DOQI clinical practice guidelines and clinical practice recommendations for diabetes and chronic kidney disease. Am J Kidney Dis. 2007; 4(Suppl 2): S12.
 
8.
Mogensen CE. Prediction of clinical diabetic nephropathy in IDDM patients. Alternatives to microalbuminuria? Diabetes 1990; 39: 761.
 
9.
Soergel M, Kirschstein M, Busch C, Danne T, Gellermann J, Holl R i wsp. Oscillometric twenty-four-hour ambulatory blood pressure values in healthy children and adolescents: a multicenter trial including 1141 subjects. J Pediatr. 1997; 130(2): 178-184.
 
10.
Wühl E, Witte K, Soergel M, Mehls O, Schaefer F. Distribution of 24-h ambulatory blood pressure in children: normalized reference values and role of body dimensions. German Working Group on Pediatric Hypertension. J Hypertens. 2002; 20(10): 1995-2007.
 
11.
Schwartz GJ, Munoz A, Schneider MF, i wsp. New equations to es-timate GFR in children with CKD. J Am Soc Nephrol. 2009; 20: 629-637.
 
12.
Litwin M, Niemirska A. Nadciśnienie tętnicze pierwotne i zaburzenia metaboliczne u dzieci i młodzieży. Forum Zaburzeń Metabolicznych 2011; 2(2): 124–131.
 
13.
Machnica Ł, Deja G, Jarosz-Chobot P. Nadciśnienie tętnicze oraz stan przednadciśnieniowy u dzieci i młodzieży chorującej na cukrzycę typu 1. End, Diab, Ch Przem Materii Wieku Rozw. 2008; 14(4): 215-219.
 
14.
Suláková T, Janda J, Cerná J, Janstová V, Suláková A, Slaný J, i wsp. Arterial HTN in children with T1DM-frequent and not easy to diagnose. Pediatr Diabetes. 2009; 10(7): 441-448.
 
15.
Pletcher MJ, Bibbins-Domingo K, Lewis CE. Prehypertension during young adulthood and coronary calcium later in life. Ann Intern Med. 2008; 149: 191.
 
16.
Vasan RS, Larson MG, Leip EP, Kannel WB, Levy D. Assessment of frequency of progression to hypertension in non-hypertensive participants in the Framingham Heart Study: a cohort study. Lancet 2001; 358: 1682.
 
17.
Ayala DE, Moyá A, Crespo JJ, Castineira C, Domínguez-Sardina M, Gomara S, i wsp. Circadian Pattern of Ambulatory Blood Pressure in Hypertensive Patients With and Without Type 2 Diabetes. Chronobiol nt. 2013; 30(1-2): 99-115.
 
18.
Zhang L, Krzentowski G, Albert A, Lefebvre PJ. Factors predictive of nephropathy in DCCT Type 1 diabetic patients with good or poor metabolic control. Diabet Med. 2003; 20(7): 580-585.
 
19.
Azar ST, Birbari A. Nocturnal blood pressure elevation in patients with type 1 diabetes receiving intensive insulin therapy compared with that in patients receiving conventional insulin therapy. J Clin Endocrinol Metab. 1998; 83(9): 3190-3193.
 
eISSN:2084-4905
ISSN:2083-4543