Department of Pediatric Endocrinology and Diabetes, University Hospital Jena, Jena, Germany.
Department of Pediatric Endocrinology and Diabetology, University Hospital Munich, Munich, Germany.
Pediatr Diabetes. 2017 Dec;18(8):874-882. doi: 10.1111/pedi.12502. Epub 2017 Jan 24.
The combination of high blood pressure and hyperglycemia contributes to the development of diabetic complications. Ambulatory monitoring of blood pressure (ABPM) is seen as standard to assess blood pressure (BP) regulation.
We evaluated 24-hour BP regulation in 3529 children with type 1 diabetes, representing 5.6% of the patients <20 years of age documented in the DPV registry, and studied the influence of BP parameters including pulse pressure (PP) and blood pressure variability (BPV) on microalbuminuria (MA) and diabetic retinopathy (DR).
BP was increased in this selected cohort of children with diabetes compared to healthy German controls (standard deviation score (SDS) day: systolic BP (SBP) +0.06, mean arterial pressure (MAP) +0.08, PP +0.3; night: SBP +0.6, diastolic BP +0.6, MAP +0.8), while daytime diastolic BP (SDS -0.2) and dipping of SBP and MAP were reduced (SBP -1.1 SDS, MAP 12.4% vs 19.4%), PP showed reverse dipping (-0.7 SDS). Children with microvascular complications had by +0.1 to +0.75 SDS higher BP parameters, except of nocturnal PP in MA and diurnal and nocturnal PP in DR. Reverse dipping of PP was more pronounced in the children with MA (-5.1% vs -0.8%) and DR (-2.6% vs -1.0%). BP alteration was stronger in girls and increased with age.
There is an early and close link between 24-hour blood pressure regulation and the development of diabetic complications not only for systolic, diastolic, and mean arterial BP but also for the derived BP parameter PP and BPV in our selected patients.
高血压和高血糖的结合导致糖尿病并发症的发展。动态血压监测（ABPM）被视为评估血压（BP）调节的标准。
我们评估了 3529 名 1 型糖尿病儿童的 24 小时 BP 调节情况，这些儿童占 DPV 登记处记录的<20 岁患者的 5.6%，并研究了包括脉压（PP）和血压变异性（BPV）在内的 BP 参数对微量白蛋白尿（MA）和糖尿病视网膜病变（DR）的影响。
与健康的德国对照组相比，该选定的糖尿病儿童队列的 BP 升高（标准差评分（SDS）日间：收缩压（SBP）+0.06，平均动脉压（MAP）+0.08，PP+0.3；夜间：SBP+0.6，舒张压+0.6，MAP+0.8），而白天舒张压（SDS-0.2）和 SBP 和 MAP 的下降幅度减少（SBP-1.1 SDS，MAP 为 12.4%比 19.4%），PP 呈反向下降（-0.7 SDS）。有微血管并发症的儿童的 BP 参数高 0.1 至 0.75 SDS，除了 MA 中的夜间 PP 和 DR 中的日间和夜间 PP。MA（-5.1%比-0.8%）和 DR（-2.6%比-1.0%）中 PP 的反向下降更为明显。BP 变化在女孩中更强，并随年龄增长而增加。
在我们选定的患者中，24 小时血压调节与糖尿病并发症的发展之间存在早期且密切的联系，不仅与收缩压、舒张压和平均动脉压有关，还与衍生的 BP 参数 PP 和 BPV 有关。
