Vascular Endothelial Dysfunction Involved in Hypertension Development in T1D

Vascular endothelial dysfunction and inflammation contribute to the development of premature arterial stiffening and hypertension in patients with type 1 diabetes (T1D), according to a 20-year life-course study published in Diabetologia.

Using a longitudinal design, researchers examined data on blood pressure and biomarkers of endothelial dysfunction and inflammation (C-reactive protein, soluble intracellular adhesion molecule 1, soluble vascular cellular adhesion molecule-1, and soluble E-selectin) from 277 patients who were followed for 20 years after a diagnosis of T1D.

The researchers found that blood pressure increased significantly during this time and that increases were noted in all biomarkers except soluble E-selectin, which decreased over time. These increases occurred early in the course of disease and preceded elevations in blood pressure.

Higher levels of soluble intracellular adhesion molecule 1 and soluble vascular cellular adhesion molecule 1, but not C-reactive protein or soluble E-selectin, at baseline and during follow-up predicted increased levels of pulse pressure, and higher levels of soluble vascular cellular adhesion molecule 1 at baseline and during follow-up predicted an increased prevalence and incidence of hypertension.

These associations were determined to be independent of age, sex, smoking history, and other relevant risk factors, except for body mass index, which was associated with subsequent pulse pressure, levels of C-reactive protein, and the prevalence and incidence of hypertension. In addition, there was no evidence that higher levels of blood pressure or hypertension affected subsequent increases in these biomarkers.

Therefore, levels of soluble intracellular adhesion molecule-1 and soluble vascular cellular adhesion molecule-1 should be monitored after the onset of type 1 diabetes to help identify patients at high risk who may need intensified/tailored treatment. Weight gain should also be monitored in patients with type 1 diabetes. The authors concluded that, “Targeting endothelial dysfunction/inflammation in the early stages of diabetes may slow down the accelerated arterial aging characteristic of this disease and prevent related cardiovascular sequelae.”

Reference

Ferreira I, Hovind P, Schalkwijk CG, Parving HH, Stehouwer CDA, Rossing P. Biomarkers of inflammation and endothelial dysfunction as predictors of pulse pressure and incident hypertension in type 1 diabetes: a 20 year life-course study in an inception cohort. Diabetologia. 2018;61:231-241.