Daily blood pressure variations in patients with type 1 diabetes mellitus and nephropathy

То study a relationship between systemic hemodynamic parameters, albuminuria, and autonomic dysfunction in patients with type 1 diabetes mellitus (DM-1) without obvious nephropathy, the authors examined 55 patients in the inpatient setting. Twenty-nine patients had a normal urinary albumin excretion (CAE), 26 patients had microalbuminuria. 24-hour blood pressure monitoring (24-h BPM) was occillometrically made. The average daily, average diurnal and nocturnal values of systolic and diastolic blood pressure (BP) were significantly higher in DM-1 patients with microalbuniuria than in those with normal UAE. Routine autonomic cardiovascular tests showed that the incidence and severity of autonomic neuropathy were also higher in patients with microalbuminuria. Arterial hypertension (AH) diagnosed in compliance with the 24-h BPM criteria was detected. in 17.2%) of the DM-1 patients with normal UAE and in 42.3%) of the patients with microalbuminuria. According to the data of 24-h BPM, the incidence of arterial hypertension was 1.7 times as high as that evidenced by single BP measurements. The specific feature of circadian hemodynamic variations in patients with DM-1 was a low nocturnal BP decrease. 37.9%) of the patients with normoalbuminuria and 61.5%) of the patients with microalbuminuria had no normal (>10%)) nocturnal BP lowering. Stepwise regression analysis has ascertained that in patients with DM-1 without obvious nephropathy, systemic hemodynamic disorders are associated with albuminuria, autonomic dysfunction, and glycemic monitoring quality.

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Autonomic regulation of cardiovascular system in patients with type 1 diabetes mellitus with arterial hypertension and normal blood pressure

Arterial’naya Gipertenziya (Arterial Hypertension) ◽

10.18705/1607-419x-2015-21-4-394-402 ◽

2015 ◽

Vol 21 (4) ◽

pp. 394-402

Author(s):

Evgenia A. Shapkova ◽

Oleg V. Mamontov ◽

Anna A. Bystrova ◽

Tatyana L. Karonova

Keyword(s):

Diabetes Mellitus ◽

Blood Pressure ◽

Type 1 Diabetes ◽

Arterial Hypertension ◽

Type 1 Diabetes Mellitus ◽

Cardiovascular System ◽

Autonomic Regulation ◽

Normal Blood ◽

Normal Blood Pressure

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Hyperfiltration, urinary albumin excretion, and ambulatory blood pressure in adolescents with Type 1 diabetes mellitus

AJP Renal Physiology ◽

10.1152/ajprenal.00400.2017 ◽

2018 ◽

Vol 314 (4) ◽

pp. F667-F674 ◽

Cited By ~ 14

Author(s):

Julie A. Lovshin ◽

Marko Škrtić ◽

Petter Bjornstad ◽

Rahim Moineddin ◽

Denis Daneman ◽

...

Keyword(s):

Diabetes Mellitus ◽

Blood Pressure ◽

Type 1 Diabetes ◽

Type 1 Diabetes Mellitus ◽

Ambulatory Blood Pressure ◽

Blood Pressure Monitoring ◽

Urinary Albumin ◽

Rapid Decline

Adolescents with Type 1 diabetes mellitus (T1DM) are at risk for hyperfiltration and elevated urinary albumin-to-creatinine ratio (ACR), which are early indicators of diabetic nephropathy. Adolescents with T1DM also develop early changes in blood pressure, cardiovascular structure, and function. Our aims were to define the relationships between hyperfiltration, ACR, and 24-h ambulatory blood pressure over time in adolescents with T1DM. Normotensive, normoalbuminuric adolescents ( n = 98) with T1DM underwent baseline and 2-yr 24-h ambulatory blood pressure monitoring, glomerular filtration rate (eGFR) estimated by cystatin C (Larsson equation), and ACR measurements. Linear regression models adjusted for diabetes duration, sex, and HbA1c were used to determine associations. Hyperfiltration (eGFR ≥ 133 ml/min) was present in 31% at baseline and 21% at 2-yr follow-up. Hyperfiltration was associated with greater odds of rapid GFR decline (>3 ml·min−1·yr−1) [OR: 5.33, 95%; CI: 1.87–15.17; P = 0.002] over 2 yr. Natural log of ACR at baseline was associated with greater odds of hyperfiltration (OR: 1.71, 95% CI: 1.00–2.92; P = 0.049) and 2-yr follow-up (OR: 2.14, 95%; CI: 1.09–4.19; P = 0.03). One SD increase in eGFR, but not ln ACR, at 2-yr follow-up conferred greater odds of nighttime nondipping pattern (OR: 1.96, 95% CI: 1.06–3.63; P = 0.03). Hyperfiltration was prevalent at baseline and at 2-yr follow-up, predicted rapid decline in GFR, and was related to ACR. Elevated GFR at 2-yr follow-up was associated with nighttime nondipping pattern. More work is needed to better understand early relationships between renal hemodynamic and systemic hemodynamic changes in adolescents with T1DM to reduce future cardiorenal complications.

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Can ambulatory blood pressure monitoring detect early diastolic dysfunction in children with type 1 diabetes mellitus: correlations with B-type natriuretic peptide and tissue Doppler findings

Pediatric Diabetes ◽

10.1111/pedi.12234 ◽

2014 ◽

Vol 17 (1) ◽

pp. 21-27 ◽

Cited By ~ 6

Author(s):

Mustafa Kır ◽

Benhur Cetin ◽

Korcan Demir ◽

Nuh Yılmaz ◽

Ozgur Kızılca ◽

...

Keyword(s):

Diabetes Mellitus ◽

Blood Pressure ◽

Type 1 Diabetes ◽

Diastolic Dysfunction ◽

Type 1 Diabetes Mellitus ◽

Ambulatory Blood Pressure ◽

Blood Pressure Monitoring ◽

Tissue Doppler ◽

Pressure Monitoring

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Echocardiographic Correlates of Blood Pressure in Normoalbuminuric Prehypertensive Adults with Type 1 Diabetes Mellitus: An Ambulatory Blood Pressure Monitoring Study

The Internet Journal of Cardiology ◽

10.5580/952 ◽

2006 ◽

Vol 3 (2) ◽

Keyword(s):

Diabetes Mellitus ◽

Blood Pressure ◽

Type 1 Diabetes ◽

Type 1 Diabetes Mellitus ◽

Ambulatory Blood Pressure Monitoring ◽

Ambulatory Blood Pressure ◽

Blood Pressure Monitoring ◽

Pressure Monitoring ◽

Monitoring Study

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Diagnostic Significance of a Mild Decrease of Baroreflex Sensitivity With Respect to Heart Rate in Type 1 Diabetes Mellitus

Physiological Research ◽

10.33549/physiolres.932510 ◽

2013 ◽

pp. 605-613

Author(s):

J. SVAČINOVÁ ◽

N. HONZÍKOVÁ ◽

A. KRTIČKA ◽

I. TONHAJZEROVÁ ◽

K. JAVORKA ◽

...

Keyword(s):

Diabetes Mellitus ◽

Blood Pressure ◽

Heart Rate ◽

Type 1 Diabetes ◽

Type 1 Diabetes Mellitus ◽

Autonomic Dysfunction ◽

Baroreflex Sensitivity ◽

Clinical Signs ◽

Diagnostic Significance

Decreased baroreflex sensitivity is an early sign of autonomic dysfunction in patients with type-1 diabetes mellitus. We evaluated the repeatability of a mild baroreflex sensitivity decrease in diabetics with respect to their heart rate. Finger blood pressure was continuously recorded in 14 young diabetics without clinical signs of autonomic dysfunction and in 14 age-matched controls for 42 min. The recordings were divided into 3-min segments, and the mean inter-beat interval (IBI), baroreflex sensitivity in ms/mm Hg (BRS) and mHz/mm Hg (BRSf) were determined in each segment. These values fluctuated in each subject within 42 min and therefore coefficients of repeatability were calculated for all subjects. Diabetics compared with controls had a decreased mean BRS (p=0.05), a tendency to a shortened IBI (p=0.08), and a decreased BRSf (p=0.17). IBI correlated with BRS in diabetics (p=0.03); this correlation was at p=0.12 in the controls. BRSf was IBI independent (controls: p=0.81, diabetics: p=0.29). We conclude that BRS is partially dependent on mean IBI. Thus, BRS reflects not only an impairment of the quick baroreflex responses of IBI to blood pressure changes, but also a change of the tonic sympathetic and parasympathetic heart rate control. This is of significance during mild changes of BRS. Therefore, an examination of the BRSf index is highly recommended, because this examination improves the diagnostic value of the measurement, particularly in cases of early signs of autonomic dysfunction.

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