BLOOD PRESSURE PROFILE IN TYPE 1 DIABETES MELLITUS

Abstract

Background: The precise occurrence of hypertension in type 1 diabetes mellitus may be foreseen by monitoring any circadian pressure changes – it seems that an increase in the nocturnal systolic blood pressure is the first detectable manifestation. Blood pressure may be influenced by a series of factors, such as: microalbuminuria, lipid imbalance, HbA1c, history of diabetes mellitus, insulin treatment. Material and method: The study included 315 patients suffering from type 1 diabetes mellitus, with a history of disease older than 10 years, recorded in the Diabetes, utrition and Metabolic Disease Center of Iaşi. Their blood pressure was permanently monitored using a portable oscillometer, which is an Automatic Blood Pressure Monitoring (ABPM) – Oscar 2 device, periodically calibrated and checked. Results: 119 patients from the group under survey suffered from hypertension. Statistically speaking, 67.5% of the type 1 diabetes mellitus patients experienced non-dipper blood pressure and a moderate negative correlation between systolic blood pressure and HbA1c. The gathered data suggested a direct connection between type 1 diabetes mellitus blood pressure changes and nutritional status. The study revealed no significant statistical correlation between blood pressure and the overall insulin intake; however, the closest blood pressure variability connection was revealed in patients having several shots of insulin per day. Blood pressure, objectively determined by the ABPM device, was higher in type 1 diabetes mellitus patients with a long history of disease, while their nocturnal blood pressure drop was small, and the physiological dipping phenomenon diminished. Conclusions: Type 1 diabetes mellitus blood pressure depends on the history of the disease, on the nutritional status, on the insulin treatment and also on the metabolic control quality. An early nocturnal BP rise may play a key role in detecting disease progression towards diabetic nephropathy – useful as potential marker and it may account for the idea of treating susceptible patients before microalbuminuria inset.