Arterial HTN in children with T1DM--frequent and not easy to diagnose.
BACKGROUND
To evaluate the diagnostic efficacy of the office blood pressure (OBP) and ambulatory blood pressure monitoring (ABPM) in the assessment of hypertension (HTN) in children with diabetes mellitus type 1 (T1DM).


METHODS
We analyzed OBP and ABPM measurements in 84 diabetic children (43 boys) obtained at a median age of 14.9 yr and 6.3 +/- 3.5 yr after diagnosis of T1DM. OBP and ABPM results were converted into standard deviation scores (SDS). In addition, we analyzed blood pressure loads and nighttime dipping. The comparison between OBP and ABPM was performed using kappa coefficient and receiver operator curve (ROC).


RESULTS
HTN was diagnosed in 43/84 (51%) patients using OBP (>95th percentile), and in 24/84 (29%) patients using ABPM ( > or = 95th percentile during 24 h, day or night). Both methods were in agreement in 33 ABPM normotensive and 16 ABPM hypertensive patients (most had nighttime HTN); 32% patients had white-coat HTN and 9.5% patients had masked HTN. The kappa coefficient was 0.175 (95% CI from -0.034 to 0.384) suggesting poor agreement between OBP and ABPM. Diastolic OBP was a better predictor of ABPM HTN (ROC area under the curve (AUC) = 0.71 +/- 0.06) than systolic OBP (AUC = 0.58 +/- 0.07). The percentage of non-dippers ranged from 7 to 23% in ABPM normotensive patients, and 21-42% in ABPM hypertensive patients who also had significantly higher BP loads (p < 0.0001).


CONCLUSIONS
Children with T1DM often suffer from nocturnal, white coat- and masked HTN, which can not be assessed and predicted by the OBP.
Suláková
Terezie
T
Department of Pediatrics, University Hospital Ostrava and Faculty of Health Studies, University of Ostrava, 708 52 Ostrava, Czech Republic. terezie.sulakova@fnspo.cz
Janda
Jan
J
Cerná
Jana
J
Janstová
Vlasta
V
Suláková
Astrid
A
Slaný
Jaroslav
J
Feber
Janusz
J
D000293:Adolescent; D000419:Albuminuria / Q000453:epidemiology; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D001827:Body Height; D001835:Body Weight; D002648:Child; D002940:Circadian Rhythm; D003404:Creatinine / Q000652:urine; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D003925:Diabetic Angiopathies / Q000175:diagnosis* / Q000503:physiopathology; D003971:Diastole; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013599:Systole; D055815:Young Adult
D003404:Creatinine; D006442:Glycated Hemoglobin