ARTERIAL HYPERTENSION IN PATIENTS WITH LONG DURATION TYPE 1 DIABETES MELLITUS

Abstract

Objective: Prognosis in Type 1 diabetes mellitus (T1DM) patients is constantly improving and the role of other cardiovascular risk factors, e.g. hypertension is gradually increasing. The effective management of both conditions is important for the prevention of cardio-vascular diseases (CVD). Aim: to assess the blood pressure (BP) in patients with long-duration T1DM compared to controls and to evaluate arterial hypertension (AH) management in them. Design and method: A study of 124 patients of T1DM at a mean age 42.68 ± 10.4 years, 53% males, with a median duration of T1DM 24 years and mean HbA1c 8.42 ± 1.75% and 59 age- and sex matched controls. BP was measured twice with a calibrated sphygmomanometer and the mean of both measurements was used. AH was defined as BP> 140/90 mm Hg or history of AH or on antihypertensive treatment. Results: The mean systolic BP (SBP) in T1DM patients was significantly higher than in controls – 128.17 ± 18.87 vs 121.13 ± 1.26, p = 0.008, with no interaction with gender. Diastolic BP was not significantly higher – 80.28 ± 10.02 vs 77.98 ± 10.72, p = 0.16. AH was twice more prevalent in T1DM patients than in controls – 67 (54%) and 17 (27%), resp. (p = 0.001). It was due to already known hypertension - 51 (41%) vs 12 (20%), p = 0.001 while incident AH cases were equally found in T1DM and controls – 15 (25.4%) vs 4 (25%). Control of AH < 140/90 mmHg was achieved in only 35.8% of the patients with T1DM and in 37.5% of the controls, while BP< 130/80 mm Hg was even less frequent in both categories – 13.4% vs 12.5% (p = NS). Untreated were 24 (29%) of all hypertensive participants, combination treatment was prescribed in 32 (39%) and monotherapy – in 26 (32%). ACE-inhibitors were the preferred antihypertensive class, followed by beta-blockers, ARBs, diuretics, and CCBs. Conclusions: SBP is significantly higher in T1DM patients than in their healthy peers, irrespective of gender. The prevalence of AH is higher in diabetic patients with long duration even at still relatively younger age. The BP control is far from optimal in the studied population which requires more aggressive management to prevent CVD occurrence.