Ambulatory Blood Pressure Profiles in Adolescents with Type 1 Diabetes Andrew J. Ellis1,2, B.A.; David M. Maahs2, M.D. Ph.D.; Franziska K. Bishop2, M.S.; R. Paul Wadwa2, M.D. 1-Saint Louis University School of Medicine, Saint Louis, MO 2-Barbara Davis

1
Ambulatory Blood Pressure Profiles in Adolescents
with Type 1 DiabetesAndrew J. Ellis1,2, B.A.
David M. Maahs2, M.D. Ph.D. Franziska K.
Bishop2, M.S. R. Paul Wadwa2, M.D.1-Saint Louis
University School of Medicine, Saint Louis,
MO2-Barbara Davis Center for Childhood Diabetes,
University of Colorado Anschutz Medical Campus,
Aurora, CO
Conclusions
Background
Results

• Lack of nocturnal dip in SBP is present in
  adolescents with T1D and is associated with older
  age.
• T1D adolescents with non-dipping had HbA1c, BMI,
  blood pressure, and lipids that trended towards a
  worse CVD risk factor profile compared to those
  with normal nocturnal dipping.
• Further studies are needed to determine if BMI,
  HbA1c, in clinic blood pressure measurements and
  lipid levels are significantly associated with
  non-dipping in adolescents with T1D.
• Determination of modifiable factors associated
  with abnormal ABP may lead to more aggressive
  blood pressure treatment and lowering of lifetime
  risk for CVD for adolescents with T1D.

• Cardiovascular disease (CVD) is the leading cause
  of mortality in patients with type 1 diabetes
  (T1D).
• Adolescents with T1D have an increased risk for
  the development of CVD and those with abnormal
  blood pressure are at even higher risk for
  premature CVD.
• Ambulatory blood pressure (ABP) monitoring has
  been shown to be a useful measure of blood
  pressure that may be more sensitive than
  traditional in-clinic blood pressure assessment.
• Nocturnal decrease in blood pressure, or
  dipping, is a normal physiologic occurrence.
• Abnormal dipping or reduced fall in blood
  pressure (non-dipping) has been associated with
  diabetic nephropathy in adults with T1D.

• There were no differences between males and
  females with respect to age, diabetes duration,
  HbA1c, BMI, total cholesterol, HDL-c, LDL-c and
  urine ACR.
• Out of 29 participants, 15 (52) had an abnormal
  (lt10) decrease in nocturnal SBP (non-dippers).
• Participants who had an abnormal SBP dip were
  older than those with a normal SBP dip (Table 1).
• Participants with T1D who had an abnormal SBP
  dip had a higher BMI than patients with a normal
  dip (Table 1).
• Although differences did not reach statistical
  significance, HbA1c, total cholesterol, LDL-c,
  clinic SBP, and clinic DBP trended higher and
  HDL-c trended lower in non-dippers compared to
  participants with normal nocturnal SBP dip
  (pgt0.05).
• In logistic regression analyses, age, but not
  sex, BMI, clinic blood pressure, lipids or urine
  ACR, was associated with increased odds of
  non-dipping (p0.03 for age).

Table 1 Subject Characteristics by dipping status
Objective
Acknowledgments
  SBP Dip gt10 SBP Dip lt10 P-value
N 14 15 N/A
Age (years) 13.71.8 16.02.3 0.007
T1D duration (years) 6.04.2 6.75.4 0.67
Sex, male 43 67 0.20
BMI (kg/m2) 20.02.4 23.44.4 0.03
Clinic SBP (mmHg) 111.15.3 117.110.1 0.07
Clinic DBP (mmHg)  68.74.9  72.110.5 0.39
HbA1c () 8.71.5 9.92.3 0.12
Total Cholesterol (mg/dL) 157.924.0 166.746.7 0.61
HDL-c (mg/dL) 53.69.0 50.712.0 0.47
LDL-c (mg/dL) 87.915.4 97.330.5 0.41
Urine AlbuminCreatinine Ratio 61.8133 8.235.59 0.17

• The objective of this study was to assess the
  relationship between ABP profiles and in-clinic
  blood pressure measurements and to determine
  factors associated with non-dipping using ABP
  monitoring in adolescents with T1D age 12-19
  years.
• We hypothesized that T1D adolescents with an
  abnormal decrease in blood pressure (non-dippers)
  would have a worse CVD risk factor profile
  compared to T1D adolescents with normal nocturnal
  dipping.

• This research project was supported by the
  following
• NIDDK Medical Student Research Program, Grant
  3T32DK063687-09S1
• JDRF Early Career Award (11-2007-694) for Dr.
  Wadwa
• NIDDK DK 075630 for Dr. Maahs
• NIH/NCRR Colorado CTSI Grant Number UL1 RR025780.
  
• The contents of this abstract are the authors
  sole responsibility and do not necessarily
  represent official NIH views.

Methods

• ABP profiles were obtained using a SpaceLabs
  90207 monitor in 29 adolescents with T1D (age
  14.82.4 years, duration 6.24.7, HbA1c 9.22.0)
  who were part of a larger study investigating
  CVD risk factors in adolescents with T1D.
• Participants wore monitors for a 24-hour period
  with measurements recorded every 20 minutes
  during the day and every 60 minutes at night and
  recorded sleep and activity levels.
• ABP profiles were analyzed for non-dipping
  status, defined as an average SBP decrease lt10
  during sleep compared to average wakeful SBP.
• Demographic, anthropometric, and lab data were
  also collected, including age, gender, T1D
  duration, BMI, in-clinic blood pressure, HbA1c,
  lipid levels, and urine albumincreatinine ratio
  (ACR).

Figure 1 SpaceLabs 90207 ABP Monitor