Variations of ambulatory blood pressure with position in patients with type 1 diabetes: influence of disease duration and microangiopathy in a pilot study.
OBJECTIVE
To study the influence of position changes on 24-h ambulatory blood pressure (ABP) in normotensive or mildly hypertensive normoalbuminuric patients with type 1 diabetes.


METHODS
A cross-sectional evaluation of patients was staged according to the duration of diabetes (DD) and the presence of microangiopathy. We recruited 37 patients (30 men and 7 women), aged 38 +/- 12 years, who were normotensive or mildly hypertensive (diastolic blood pressure [DBP] <105 mmHg) and free of antihypertensive treatment and microalbuminuria. They were included according to DD (group 1, <5 years; group 2, > or =10 years). An additional group of seven diabetic patients with microalbuminuria and mild untreated hypertension was also investigated. We recorded 24-h ambulatory blood pressure every 15 min with a position sensor, which allowed for the discrimination between standing or supine/sitting position in the patient.


RESULTS
Mean daytime (10:00 A.M. to 8:00 P.M.) ABP in supine/sitting position did not significantly differ between groups 1 and 2. However, standing ambulatory systolic blood pressure (ASBP) and ambulatory DBP (ADBP) were significantly higher than supine/sitting ASBP and ADBP in group 1 (DeltaSBP 4 +/- 5, DeltaDPB 4 +/- 6 mmHg, P < 0.01) but not in group 2 (DeltaSBP 2 +/- 8, DeltaDBP 2 +/- 4 mmHg, P = NS). Patients free of microangiopathy presented with significantly higher ABP in standing position than in sitting/lying position, whereas patients with retinopathy and/or nephropathy exhibited no significant increase of ABP during standing.


CONCLUSIONS
The monitoring of position during ambulatory measurement of blood pressure in type 1 diabetic patients shows different patterns in relation to disease duration and the presence of microangiopathy.
Benhamou
P Y
PY
Department of Endocrinology, Grenoble University Hospital, Grenoble 38043, France. benhamou@ujf-grenoble.fr
Mouret
S
S
Quesada
J L
JL
Boizel
R
R
Baguet
J P
JP
Halimi
S
S
Mallion
J M
JM
D000328:Adult; D000419:Albuminuria; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000503:physiopathology* / Q000652:urine; D003925:Diabetic Angiopathies / Q000503:physiopathology*; D003930:Diabetic Retinopathy / Q000503:physiopathology; D003971:Diastole; D005260:Female; D006339:Heart Rate; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D008297:Male; D018579:Patient Selection; D010865:Pilot Projects; D011187:Posture; D013599:Systole; D013997:Time Factors