Altered age-related blood pressure pattern in type 1 diabetes.
BACKGROUND
Pulse pressure (PP) increases with age as a result of arterial stiffening and is a powerful predictor of cardiovascular disease. Type 1 diabetes is associated with excessive cardiovascular mortality and increased arterial stiffness. We examined whether the age-related blood pressure changes in type 1 diabetic patients differ from those of the nondiabetic


RESULTS
We performed a cross-sectional, case-control study of 2988 consecutively selected diabetic subjects and 5486 randomly selected nondiabetic control subjects. Blood pressure was measured twice by mercury sphygmomanometry on a single occasion. Compared with controls, diabetic subjects had a higher systolic blood pressure in all age groups, whereas diastolic blood pressure was higher in those <40 years but lower in those >45 years of age. Consequently, diabetic subjects had a higher PP and a higher prevalence of isolated systolic hypertension. The early age-related rise in PP was more pronounced in subjects with diabetic nephropathy but was also evident in diabetic subjects with normal albumin excretion rate. In a multiple regression analysis, PP in diabetic patients was associated with age, male sex, duration of diabetes, and albuminuria.


CONCLUSIONS
A higher systolic pressure and an earlier decrease in diastolic pressure result in a higher and more rapidly increasing PP in type 1 diabetic patients. Our findings indicate accelerated arterial aging, which may contribute to the higher cardiovascular morbidity and mortality in these patients.
Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland.
Mats
M
Rönnback
Johan
J
Fagerudd
Carol
C
Forsblom
Kim
K
Pettersson-Fernholm
Antti
A
Reunanen
Per-Henrik
PH
Groop
D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000375:Aging / Q000502:physiology*; D000419:Albuminuria / Q000453:epidemiology / Q000209:etiology; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000502:physiology*; D015992:Body Mass Index; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000503:physiopathology*; D003928:Diabetic Nephropathies / Q000453:epidemiology; D003971:Diastole / Q000502:physiology; D004198:Disease Susceptibility; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D013599:Systole / Q000502:physiology; D014655:Vascular Resistance / Q000502:physiology
D000959:Antihypertensive Agents