Preview

Russian Journal of Cardiology

Advanced search

Blood pressure phenotypes in young patients with type 1 diabetes

https://doi.org/10.15829/1560-4071-2020-3-3729

Abstract

Aim. To study phenotypes of clinic and 24-hour ambulatory blood pressure (BP), to determine their associations with arterial stiffness parameters, and to assess global cardiovascular risk (CVR) in young patients with type 1 diabetes (T1D).

Material and methods. The presented cross-sectional single-center study included 81 T1D patients without a history of hypertension (HTN) and other cardiovascular diseases (CVD) (men — 39%; median age — 27 years; median duration of T1D — 6 years). All participants underwent a routine clinical and laboratory testing, measurement of clinic and 24-hour ambulatory BP (BPLab Vasotens), assessment of central BP and arterial stiffness parameters using applanation tonometry technique. BP phenotypes were analyzed with diagnostic criteria for HTN by ESC/ESH 2018 guidelines. CVR was assessed using the SCORE 10-year risk calculator (ESC 2019). The differences were considered significant at p<0,05.

Results. The prevalence of true HTN was 6,2%, masked HTN — 38,3%. Isolated nocturnal HTN was revealed in 30,7% of patients with clinic BP <140/90 mm Hg. The subgroup with masked HTN was dominated by patients with normal clinic BP (58,1%) and in most cases was characterized by isolated diastolic BP increase (64,5%). Masked HTN was associated with a higher carotid-femoral pulse wave velocity (PWV) (median — 7,2 versus 6,3 m/s, p=0,002). The most common profiles of nocturnal BP decrease were non-dipper (63.9%) and night-picker (16.6%). High and very high CVR was recorded in 87,7% of patients. Conclusion. Hypertension occurs in 44,5% of young patients with type 1 diabetes and is characterized by a high prevalence of masked isolated nocturnal HTN and non-dipping. Masked HTN is associated with a higher carotid-femoral PWV. High and very high 10-year CVR was recorded in 87,7% of patients.

About the Authors

Zh. D. Kobalava
Peoples’ Friendship University of Russia
Moscow


Yu. V. Stavtseva
Peoples’ Friendship University of Russia
Russian Federation
Moscow


E. A. Troitskaya
Peoples’ Friendship University of Russia
Moscow


A. F. Safarova
Peoples’ Friendship University of Russia
Moscow


A. E. Petrosyan
Peoples’ Friendship University of Russia
Moscow


References

1. Diaz-Valencia PA, Bougneres P, Valleron AJ. Global epidemiology of type 1 diabetes in young adults and adults: a systematic review. BMC Public Health. 2015;15:255. doi:10.1186/s12889-015-1591-y.

2. Xu G, Liu B, Sun Y, et al. Prevalence of diagnosed type 1 and type 2 diabetes among US adults in 2016 and 2017: population based study. BMJ. 2018;362:k1497. doi:10.1136/bmj.k1497.

3. Shestakova MV, Vikulova OK, Zheleznyakova AV, et al. Diabetes epidemiology in Russia: what has changed over the decade? Therapeutic Archive. 2019;91(10):4-13. (In Russ.). doi:10.26442/00403660.2019.10.000364.

4. Schofield J, Ho J, Soran H. Cardiovascular Risk in Type 1 Diabetes Mellitus. Diabetes Ther. 2019;10(3):773-89. doi:10.1007/s13300-019-0612-8.

5. de Ferranti SD, de Boer IH, Fonseca V, et al. Type 1 diabetes mellitus and cardiovascular disease: a scientific statement from the American Heart Association and American Diabetes Association. Circulation. 2014;130(13):1110-30. doi:10.1161/CIR.0000000000000034.

6. Collado-Mesa F, Colhoun HM, Stevens LK, et al. Prevalence and management of hypertension in type 1 diabetes mellitus in Europe: the EURODIAB IDDM Complications Study. Diabet Med. 1999;16(1):41-8. doi:10.1046/j.1464-5491.1999.00007.x.

7. Maahs DM, Kinney GL, Wadwa P, et al. Hypertension prevalence, awareness, treatment, and control in an adult type 1 diabetes population and a comparable general population. Diabetes Care. 2005;28(2):301-6. doi:10.2337/diacare.28.2.30.1

8. Epstein M, Sowers JR. Diabetes mellitus and hypertension. Hypertension. 1992;19(5):403. doi:10.1161/01.hyp.19.5.403.

9. National clinical guidelines Diagnosis and treatment of patients with chronic obstructive pulmonary disease and hypertension 2017. (In Russ.) https://www.rnmot.ru/public/uploads/RNMOT/clinical/2017/ХОБЛ%20и%20АГ%20Малявин_250618.pdf

10. Rodrigues TC, Canani LH, Viatroski RS, et al. Masked hypertension, nocturnal blood pressure and retinopathy in normotensive patients with type 1 diabetes. Diabetes Res Clin Pract. 2010;87:240-5. doi:10.1016/j.diabres.2009.10.016

11. Mateo-Gavira I, Vilchez-Lopez FJ, Garcia-Palacios MV, et al. Nocturnal blood pressure is associated with the progression of microvascular complications and hypertension in patients with type 1 diabetes mellitus. J Diabetes Complicat. 2016;30:1326-32. doi:10.1016/j.jdiacomp.2016.05.021.

12. Lithovius R, Gordin D, Forsblom C, et al. Ambulatory blood pressure and arterial stiffness in individuals with type 1 diabetes, Diabetologia. 2018;61:1935-45. doi:10.1007/s00125018-4648-5.

13. Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39(33):3021-104. doi:10.1093/eurheartj/ehy339.

14. Chazova IE, Zhernakova YuV, on behalf of the experts. Clinical guidelines. Diagnosis and treatment of arterial hypertension. Systemic Hypertension. 2019;16(1):6-31. (In Russ.). doi:10.26442/2075082X.2019.1.190179.

15. Whelton PK, Carey RM, Aronow WS et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/ APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018;71:e127-e248. doi:10.1016/j.jacc.2017.11.006.

16. George B, Bantwal G, Ayyar V, Mathew V. Occurrence of increased arterial stiffness in a cohort of adult patients with type 1 diabetes mellitus when compared to normoglycemic controls. J Diabetes Sci Technol. 2015;9:138-44. doi:10.1177/1932296814551982.

17. O’Brien E, Parati G, Stergiou G, et al. European Society of Hypertension position paper on ambulatory blood pressure monitoring. J Hypertens. 2013;31(9):1731-68. doi:10.1097/HJH.0b013e328363e964.

18. Vasyuk YA, Ivanova SV, Shkolnik EL, et al. Consensus of Russian experts on the evaluation of arterial stiffness in clinical practice. Cardiovascular Therapy and Prevention. 2016;15(2):4-19. (In Russ.) doi:10.15829/1728-8800-2016-2-4-19.

19. Cosentino F, Grant PJ, Aboyans V, et al. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J. 2020;41(2):255-323. doi:10.1093/eurheartj/ehz486.

20. Salles GF, Reboldi G, Fagard RH, et al. Prognostic effect of the nocturnal blood pressure fall in hypertensive patients: The Ambulatory Blood Pressure Collaboration in Patients With Hypertension (ABC-H) Meta-Analysis. Hypertension. 2016;67(4):693-700. doi:10.1161/HYPERTENSIONAHA.115.06981.

21. Brooks B, Molyneaux L, Yue DK. Augmentation of central arterial pressure in type 1 diabetes. Diabetes Care. 1999;22:1722-7. doi:10.2337/diacare.22.10.1722.

22. Wilkinson IB, MacCallum H, Rooijmans D, et al. Increased augmentation index and systolic stress in type 1 diabetes mellitus. QJM. 2000;93:441-8. doi:10.1093/qjmed/93.7.441.

23. Shah AS, Wadwa RP, Dabelea D, et al. Arterial stiffness in adolescents and young adults with and without type 1 diabetes: the SEARCH CVD study. Pediatr Diabetes. 2015;16:36774. doi:10.1111/pedi.12279.

24. Mattace-Raso F, Hofman A, Verwoert GC, et al. Determinants of pulse wave velocity in healthy people and in the presence of cardiovascular risk factors: ‘establishing normal and reference values’. Eur Heart J. 2010 Oct;31(19):2338-50. doi:10.1093/eurheartj/ehq165.

25. Yano Y, Kario K. Nocturnal blood pressure and cardiovascular disease: a review of recent advances. Hypertens Res. 2012;35(7):695-701. doi:10.1038/hr.2012.26.

26. Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J. 2020 Jan 1;41(1):111-88. doi:10.1093/eurheartj/ehz455.


Review

For citations:


Kobalava Zh.D., Stavtseva Yu.V., Troitskaya E.A., Safarova A.F., Petrosyan A.E. Blood pressure phenotypes in young patients with type 1 diabetes. Russian Journal of Cardiology. 2020;25(3):3729. https://doi.org/10.15829/1560-4071-2020-3-3729

Views: 1401


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 1560-4071 (Print)
ISSN 2618-7620 (Online)