title: Blood pressure regulation determined by ambulatory blood pressure profiles in children and adolescents with type 1 diabetes mellitus: Impact on diabetic complications.
abstract: BACKGROUND
  The combination of high blood pressure and hyperglycemia contributes to the development of diabetic complications. Ambulatory monitoring of blood pressure (ABPM) is seen as standard to assess blood pressure (BP) regulation.
  
  
  OBJECTIVE
  We evaluated 24-hour BP regulation in 3529 children with type 1 diabetes, representing 5.6% of the patients <20 years of age documented in the DPV registry, and studied the influence of BP parameters including pulse pressure (PP) and blood pressure variability (BPV) on microalbuminuria (MA) and diabetic retinopathy (DR).
  
  
  RESULTS
  BP was increased in this selected cohort of children with diabetes compared to healthy German controls (standard deviation score (SDS) day: systolic BP (SBP) +0.06, mean arterial pressure (MAP) +0.08, PP +0.3; night: SBP +0.6, diastolic BP +0.6, MAP +0.8), while daytime diastolic BP (SDS -0.2) and dipping of SBP and MAP were reduced (SBP -1.1 SDS, MAP 12.4% vs 19.4%), PP showed reverse dipping (-0.7 SDS). Children with microvascular complications had by +0.1 to +0.75 SDS higher BP parameters, except of nocturnal PP in MA and diurnal and nocturnal PP in DR. Reverse dipping of PP was more pronounced in the children with MA (-5.1% vs -0.8%) and DR (-2.6% vs -1.0%). BP alteration was stronger in girls and increased with age.
  
  
  CONCLUSIONS
  There is an early and close link between 24-hour blood pressure regulation and the development of diabetic complications not only for systolic, diastolic, and mean arterial BP but also for the derived BP parameter PP and BPV in our selected patients.
authors.affiliation: Department of Pediatric Endocrinology and Diabetes, University Hospital Jena, Jena, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Dost
authors.affiliation: Department of Pediatric Endocrinology and Diabetology, University Hospital Munich, Munich, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Bechtold-Dalla Pozza
authors.affiliation: Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.|German Center for Diabetes Research (DZD), Neu-Herberg, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Bollow
authors.affiliation: Pediatric Diabetes Center, Debant, Austria.
authors.forename: R
authors.initials: R
authors.lastname: Kovacic
authors.affiliation: Department of Pediatrics, Departments of Pediatrics, Garmisch-Partenkirchen, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Vogel
authors.affiliation: Hospital Böblingen, Boeblingen, Germany.
authors.forename: L
authors.initials: L
authors.lastname: Feldhahn
authors.affiliation: Department of Pediatrics, University Hospital, Freiburg, Germany.
authors.forename: K O
authors.initials: KO
authors.lastname: Schwab
authors.affiliation: Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.|German Center for Diabetes Research (DZD), Neu-Herberg, Germany.
authors.forename: R W
authors.initials: RW
authors.lastname: Holl
mesh_terms: D000293:Adolescent; D000419:Albuminuria / Q000209:etiology*; D001794:Blood Pressure; D002648:Child; D002940:Circadian Rhythm; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000503:physiopathology*; D003930:Diabetic Retinopathy / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male
keywords: blood pressure profiles; blood pressure variability; diabetic complications; pulse pressure; type 1 diabetes mellitus