Ambulatory blood pressure monitoring (ABPM) in normotensive adolescents with type 1 diabetes

: Objective: To evaluate 24-h ambulatory blood pressure monitoring (ABPM) for early detection of hypertension in adolescents with type 1 diabetes mellitus (DM1). Design:  Patients underwent fundoscopy, albuminuria determinations, two repeated autonomic cardiovascular tests, heart rate (HR) variation during deep breathing and blood pressure (BP) variation during sustained handgrip. Twenty-four hour BP measurements were taken automatically by an oscillometric portable monitor. Setting:  A specialty pediatric diabetes clinic and subjects' homes. Participants: Eighteen children aged 10–17 yr with 2+ yr of DM1, without long-term complications, and 34 controls. Results:  Higher ambulatory HR during the day than at night did not differ between DM1 subjects and controls. Mean systolic (s) and diastolic (d) BP in patients during the daytime were not significantly different from the control values. During the night, both sBP and dBP mean values in patients differed from those of controls. Statistical analysis of day and night HR and BP measurements were not different in both groups. The percentage decrease during the night in sBP and dBP was significantly smaller in patients than in controls. There were no differences by gender or duration of diabetes > or < 5 yr or by HbA1 above and below 10%. No difference in nocturnal sBP or dBP decline was observed between patients with or without abnormal autonomic test results. Conclusion: ABPM is more reliable than casual BP measurement in detecting early BP alterations during the night, before the appearance of microalbuminuria, in young patients with DM1.