BLOOD-PRESSURE TRACKING IN ADOLESCENTS WITH INSULIN-DEPENDENT DIABETES-MELLITUS

Hypertension, one of the most frequent and important complications of insulin-dependent diabetes mellitus (IDDM), usually begins in the seco nd decade of the disease and is rare in childhood. We analysed the blo od pressure (BP) levels of 106 patients (48 males, 58 females, aged 2- 16 years) in relation to sex and age and we studied the modification o f BP with years (tracking). BP levels, registered every three to six m onths, were compared with the local standard levels for age and expres sed as standard deviation scores (SDS) of the means. For each subject a regression line describing the change of the SDS over time was calcu lated by the method of least squares. The slope of this line is called trend and represents the tendency of BP to increase or decrease with time, i.e. to develop (or not) hypertension. All patients, except one 16 year old girl, had normal BP and no microalbuminuria but ten of the m presented with mean levels in the upper quartile and/or a constantly upward BP trend and were considered at risk. After a three year follo w-up four of these ten patients became frankly hypertensive with incre ased microalbuminuria. These results agree with previous findings and with the hypothesis that an increase of intraglomerular and/or systemi c BP may precede the appearance of (and even could be responsible for) microalbuminuria. The BP tracking study in IDDM children and adolesce nts could be useful for an early recognition of patients at risk of de veloping hypertension and diabetic nephropathy.