Abstract
Background: Preliminary data suggest that target organ damage (TOD) and early vascular aging (EVA) may occur in children with normal blood pressure (BP).Objectives: To analyze TOD and EVA in normotensive (BP <95th percentile on ambulatory BP monitoring) type 1 diabetes children (T1D) in comparison to healthy controls (C).Subjects: 25 T1D aged 13.9 ± 2.6 years and 22 C aged 14.0 ± 3.4 years.Methods: We analyzed age- and height-related pulse wave velocity (PWV) Z-scores and expected PWV based on age, height, and mean arterial pressure (MAP). Expected vascular age based on measured PWV was calculated from pooled pediatric and adult PWV norms. Left ventricular mass index (LVMI), estimated glomerular filtration rate (eGFR), and urinary albumin/creatinine ratio (ACR) were obtained as markers of TOD.Results: T1D and C groups did not differ in anthropometry, ambulatory, LVMI, and ACR. However, median age- and height-related PWV Z-scores were higher in T1D compared to C (1.08 vs. 0.57, p = 0.006; 0.78 vs. 0.36, p = 0.02, respectively). Mean (±SD) difference between measured and expected PWV was 0.58 ± 0.57 in T1D vs. 0.22 ± 0.59 in C, p = 0.02. The mean (±SD) difference between chronological and expected vascular age was 7.53 ± 7.74 years in T1D vs. 2.78 ± 7.01 years in C, p = 0.04.Conclusion: Increased arterial stiffness and increased intraindividual differences between expected and measured PWV as well as between chronological and expected vascular age indicate that EVA may develop in T1D children even at normal ambulatory BP levels.
Highlights
Elevated blood pressure (BP) represents an important cardiovascular risk factor with a direct relationship between the BP level and rates of stroke, myocardial infarction, and the risk of end-stage renal disease [1].In children, the BP cutoffs for increased cardiovascular risk are not clearly defined due to the lack of longitudinal studies linking childhood BP levels to long-term outcomes in adulthood [2]
Out of a total of 29 patients enrolled, 25 patients with T1D were diagnosed with ambulatory normotension based on ambulatory BP monitoring (ABPM) criteria, and they were included in the current study
Our study showed that ABPM normotensive diabetic children and adolescents had significantly increased absolute Pulse-wave velocity (PWV) as well as age- and height-related PWV subsequently converted into Z-scores (SDS) compared to their normotensive controls
Summary
The BP cutoffs for increased cardiovascular risk are not clearly defined due to the lack of longitudinal studies linking childhood BP levels to long-term outcomes in adulthood [2]. The risk of CV complications is low during childhood, but children can develop target organ damage (TOD) as a consequence of untreated hypertension [4, 5]. Recent studies suggest that even mild elevation of BP, below the hypertension threshold, or white coat hypertension (WCH) can lead to heart and vascular damage [6,7,8]. Preliminary data suggest that target organ damage (TOD) and early vascular aging (EVA) may occur in children with normal blood pressure (BP)
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