Arterial blood pressure changes in children and adolescents with insulin-dependent diabetes mellitus.

Diabetic nephropathy may develop in childhood and is often related to hypertension. The 24-hour ambulatory blood pressures were measured in 63 children with insulin-dependent diabetes mellitus and were compared with those of 54 healthy siblings. The patients were without clinical complications. The 24-hour recording of their blood pressures revealed higher 24-hour systolic blood pressure (SBP) (115.8 +/- 8.2), 24-hour diastolic blood pressure (DBP) (67.5 +/- 4.6), 24-hour mean arterial pressure (MAP) (81.8 +/- 5.2) compared with control subjects: 24-hour SBP (112.7 +/- 6.7), 24-hour DBP (64.7 +/- 4.1), 24-hour MAP (78.9 +/- 4.5) (p = 0.03, p = 0.001, p = 0.002, respectively). Of the daytime blood pressures, SBP, DBP, MAP were also higher (117.7 +/- 8.7, 69.7 +/- 5.2, 83.8 +/- 5.8) compared with those of siblings (114.9 +/- 6.9, 67.3 +/- 4.3, 81.1 +/- 4.9) (p = 0.05, p = 0.009, p = 0.008, respectively). Of the nighttime blood pressures, SBP, DBP, MAP were higher in patients (108.7 +/- 8.9, 59.5 +/- 6.9, 74.6 +/- 6.9) compared with control subjects (104.8 +/- 7.0, 55.1 +/- 5.0, 70.5 +/- 5.1) (p = 0.01, p = 0.0002, p = 0.0006, respectively). Furthermore, the blood pressure burden was evaluated. Blood pressure burden was defined as the percentage of the increased blood pressure readings greater than the 95th percentile divided by the total number of recorded blood pressures during a corresponding period. Patients had a 43% higher 24-hour SBP burden (19.6 +/- 16.5) and a 50% higher 24-hour DBP burden (12.3 +/- 9.6) in relation to that of control subjects (13.7 +/- 12.8, 8.3 +/- 12.3) (p = 0.03, p = 0.009, respectively). The SBP burden (17.9 +/- 14.6) and DBP burden (11.5 +/- 9.2) of the day was approximately 50% higher in the patients in the relation to control subjects (11.9 +/- 11.1, 7.8 +/- 6.7) (p = 0.01, p = 0.01, respectively). Therefore it seems that hemodynamic changes may appear early in children with diabetes.