Ambulatory blood pressure and arterial stiffness in individuals with type 1 diabetes

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Finndiane Study Grp 2018 , ' Ambulatory blood pressure and arterial stiffness in individuals with type 1 diabetes ' , Diabetologia , vol. 61 , no. 9 , pp. 1935-1945 . https://doi.org/10.1007/s00125-018-4648-5

Title: Ambulatory blood pressure and arterial stiffness in individuals with type 1 diabetes
Author: Finndiane Study Grp
Date: 2018-09
Language: eng
Number of pages: 11
Belongs to series: Diabetologia
ISSN: 0012-186X
URI: http://hdl.handle.net/10138/304169
Abstract: Aims/hypothesis This study aimed to assess the use of ambulatory BP monitoring (ABPM) to identify the presence of masked, nocturnal and white-coat hypertension in individuals with type 1 diabetes, patterns that could not be detected by regular office-based BP monitoring alone. We also analysed associations between BP patterns and arterial stiffness in order to identify individuals at cardiovascular risk. Methods This substudy included 140 individuals with type 1 diabetes from the Helsinki metropolitan area, who attended the Finnish Diabetic Nephropathy Study (FinnDiane) Centre in Helsinki between January 2013 and August 2017. Twenty-four hour ABPM and pulse wave analysis were performed simultaneously using a validated non-invasive brachial oscillometric device (Mobil-O-Graph). Definitions of hypertension were based on the European Society of Hypertension guidelines. Masked hypertension was defined as normal office BP (BP obtained using a standardised automated BP device) but elevated 24 h ABPM, and white-coat hypertension as elevated office BP but normal 24 h ABPM. Results A total of 38% of individuals were normotensive and 33% had sustained hypertension, while 23% had masked and 6% had white-coat hypertension. About half of the cohort had increased absolute levels of night-time BP, half of whom were untreated. In the ambulatory setting, central BP and pulse wave velocity (PWV) were higher in participants with masked hypertension than in those with normotension (p <0.001). In a multivariable linear regression model adjusted for age, sex, BMI, antihypertensive treatment and eGFR, masked hypertension was independently associated with higher 24 h PWV ((3 0.50 [95% CI 0.34, 0.66]), but not with PWV obtained during resting conditions (adjusted 13 0.28 [95% CI -0.53, 1.10]), using normotension as the reference group. Conclusions/interpretation ABPM analysis revealed that one-quarter of the participants with type 1 diabetes had masked hypertension; these individuals would not have been detected by office BP alone. Moreover, arterial stiffness was increased in individuals with masked hypertension. These findings support the use of ABPM to identify individuals at risk of cardiovascular disease.
Subject: Ambulatory blood pressure
Arterial stiffness
Blood pressure patterns
Cardiovascular risk
Masked hypertension
Nocturnal hypertension
Pulse wave velocity
Type 1 diabetes
White-coat hypertension
PULSE-WAVE VELOCITY
CORONARY-HEART-DISEASE
MASKED HYPERTENSION
OSCILLOMETRIC ESTIMATION
RESISTANT HYPERTENSION
EUROPEAN-SOCIETY
CLINICAL-VALUE
NEPHROPATHY
MELLITUS
AUGMENTATION
3121 General medicine, internal medicine and other clinical medicine
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