Section of General Medicine C, Department of Medicine, University of Verona, Policlinico GB Rossi.
Section of Pediatric Diabetes and Metabolism, Department of Surgery, Dentistry, Gynecology and Pediatrics, University and Azienda Ospedaliera Universitaria Integrata of Verona.
J Hypertens. 2022 Dec 1;40(12):2469-2475. doi: 10.1097/HJH.0000000000003281. Epub 2022 Aug 22.
Type 1 diabetes mellitus (T1D) is a chronic disease leading to cardiovascular complications that can be diagnosed early as subclinical vascular damage. To prevent such damage, it is important to increase knowledge of the effects of the different cardiovascular risk factors in patients with T1D. The aim of our study was to assess possible associations between markers of subclinical arterial damage and traditional cardiovascular risk factors, with a special focus on peripheral blood pressure and central blood pressure (cBP), in a sample of young adults with T1D.
The study included 172 T1D patients (mean age 24.7 ± 8.7 years, duration of T1D 13.5 ± 9.6 years). Pulse wave velocity (PWV), pulse wave analysis and cBP were assessed by tonometry (SphygmoCor Xcel). Carotid intima-media thickness (cIMT) and carotid distensibility coefficient (cDC) were assessed by high-resolution echo-Doppler analysis and further examined with dedicated hardware.
Seventeen patients (10.1%) were classified as hypertensive by office peripheral blood pressure, and 48 patients (27.9%) were classified as hypertensive by cBP. One hundred sixteen patients (68.8%) had cDC under the range of normality, one patient had a PWV (0.6%) above 10 m/s, and no patients had a cIMT above 0.9 mm. In multivariable analysis, central SBP, but not metabolic parameters, remained associated with all the markers of subclinical arterial damage [cIMT ( β = 0.288 ± 0.001; P < 0.001), PWV ( β = 0.374 ± 0.007; P < 0.001), cDC ( β = -0.149 ± 0.055; P = 0.029)].
The independent association between cBP and markers of subclinical vascular damage underlines the importance of haemodynamic factors in the development of early signs of macrovascular disease in T1D patients. Further studies are warranted to better define the role of cBP to stratify cardiovascular risk, to individualize the need for follow-up and to tailor preventive strategies in T1D patients.
1 型糖尿病（T1D）是一种导致心血管并发症的慢性疾病，这种并发症可在亚临床血管损伤时被早期诊断。为了预防这种损伤，增加对 T1D 患者不同心血管危险因素影响的认识非常重要。我们的研究目的是评估亚临床动脉损伤标志物与传统心血管危险因素之间的可能关联，特别关注外周血压和中心血压（cBP），在一组年轻的 T1D 患者中进行研究。
这项研究纳入了 172 名 T1D 患者（平均年龄 24.7±8.7 岁，T1D 病程 13.5±9.6 年）。脉搏波速度（PWV）、脉搏波分析和 cBP 通过张力计（SphygmoCor Xcel）进行评估。颈动脉内中膜厚度（cIMT）和颈动脉扩张系数（cDC）通过高分辨率超声多普勒分析进行评估，并使用专用硬件进一步检查。
17 名患者（10.1%）通过外周诊室血压被归类为高血压，48 名患者（27.9%）通过 cBP 被归类为高血压。116 名患者（68.8%）的 cDC 低于正常值，1 名患者的 PWV（0.6%）高于 10m/s，没有患者的 cIMT 高于 0.9mm。多变量分析显示，中心 SBP，但不是代谢参数，与所有亚临床动脉损伤标志物均相关[cIMT（β=0.288±0.001；P<0.001）、PWV（β=0.374±0.007；P<0.001）、cDC（β=-0.149±0.055；P=0.029)]。
cBP 与亚临床血管损伤标志物之间的独立关联强调了血流动力学因素在 T1D 患者早期大血管疾病发生中的重要性。需要进一步研究以更好地确定 cBP 在分层心血管风险、个体化随访需求和制定 T1D 患者预防策略中的作用。
