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 reveale d higher 24-hour systolic blood pressure (SEP) (115.8 +/- 8.2), 24-hou r diastolic blood pressure (DBP) (67.5 +/- 4.6), 24-hour mean arterial pressure (MAP) (81.8 +/- 5.2) compared with control subjects: 24-hour SEP (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, SEP, 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, respectiv ely). Of the nighttime blood pressures, SEP, DBP, MAP were higher in p atients (108.7 +/- 8.9, 59.5 +/- 6.9, 74.6 +/- 6.9) compared with cont rol 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 b urden was evaluated. Blood pressure burden was defined as the percenta ge of the increased blood pressure readings greater than the 95th perc entile divided by the total number of recorded blood pressures during a corresponding period. Patients had a 43% higher 24-hour SEP burden ( 19.6 +/- 16.5) and a 50% higher 24-hour DBP burden (12.3 +/- 9.6) in r elation to that of control subjects (13.7 +/- 12.8, 8.3 +/- 12.3) (p = 0.03, p = 0.009, respectively). The SEP burden (17.9 +/- 14.6) and DB P burden (11.5 +/- 9.2) of the day was approximately 50% higher in the patients in relation to control subjects (11.9 +/- 11.1, 7.8 +/- 6.7) (p = 0.01, p = 0.01, respectively). Therefore it seems that hemodynam ic changes may appear early in children with diabetes.