Variations of ambulatory blood pressure with position in patients with type 1 diabetes - Influence of disease duration and microangiopathy in a pilotstudy
Py. Benhamou et al., Variations of ambulatory blood pressure with position in patients with type 1 diabetes - Influence of disease duration and microangiopathy in a pilotstudy, DIABET CARE, 24(9), 2001, pp. 1624-1628
OBJECTIVE - To study the influence of position changes on 24-h ambulatory b
lood pressure (ABP) in normotensive or mildly hypertensive normoalbuminuric
patients with type I diabetes.
RESEARCH DESIGN AND METHODS - A cross-sectional evaluation of patients was
staged according to the duration of diabetes (DD) and the presence of micro
angiopathy. We recruited 37 patients (30 men and 7 women), aged 38 12 years
, who were non-notensive or mildly hypertensive (diastolic blood pressure [
DBP] < 105 mmHg) and free of antihypertensive treatment and microalbuminuri
a, They were included according to DD (group 1, <5 years group 2, greater t
han or equal to 10 years). An additional group of seven diabetic patients w
ith microalbuminuria and mild untreated hypertension was also investigated.
We recorded 24-h ambulatory blood pressure every 15 min with a position se
nsor, which allowed for the discrimination between standing or supine/sitti
ng position in the patient.
RESULTS - Mean daytime (10:00 A.M. to 8:00 P.M.) ABP in supine/sitting posi
tion did not significantly differ between groups 1 and 2. However, standing
ambulatory systolic blood pressure (ASBP) and ambulatory DBP (ADBP) were s
ignificantly higher than supine/sitting ASBP and group 1 (Delta SBP 4 +/- 5
, Delta DPB 4 +/- 6 mmHg, P < 0.01) but not in group 2 (Delta SBP 2 +/- 8,
Delta DBP 2 +/- 4 mmHg, P = NS), Patients free of microangiopathy presented
with significantly higher ABP in standing position than in sitting/lying p
osition, whereas patients with retinopathy and/or nephropathy exhibited no
significant increase of ABP during standing.
CONCLUSION - The monitoring of position during ambulatory measurement of bl
ood pressure in type I diabeuc patients shows different pattern-- in relati
on to disease duration and the presence of microangiopathy.