Masked High Blood Pressure and Arterial Stiffness in Type 1 Diabetes

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Arterial stiffness manifestation precedes hypertension and cardiovascular disease in type 1 diabetes.
Arterial stiffness manifestation precedes hypertension and cardiovascular disease in type 1 diabetes.

A recent ambulatory blood pressure (BP) monitoring analysis indicated that many individuals with type 1 diabetes also have masked hypertension, according to a study published in Diabetologia. Research also suggested increased arterial stiffness and a greater risk for cardiovascular disease in these individuals.

Researchers performed 24-hour ambulatory BP monitoring and pulse wave analysis in unison using a validated non-invasive brachial oscillometric device (Mobile-O-Graph) on 140 individuals with type 1 diabetes. In this analysis, hypertension was defined by the European Society for Hypertension Guidelines, and masked hypertension was classified by normal office BP but elevated BP during a 24-hour ambulatory BP monitoring. The analysis revealed that 23% (n=32) of participants with type 1 diabetes had masked hypertension and elevated arterial stiffness, the latter based on pulse wave velocity.

Furthermore, 48 participants from the nationwide Finnish Diabetic Nephropathy Study (FinnDiane) cohort also underwent ambulatory BP monitoring 3 times at 5-yearly intervals. The results showed that only 3 out of 48 participants with type 1 diabetes met the criteria for masked hypertension during their first check, but as many as 16 had masked hypertension by their third ambulatory BP monitoring reading.

This sub-study was part of the FinnDiane study to identify genetic, clinical, and environmental risk factors for diabetic complications among individuals with type 1 diabetes. The main limitation of this study relates to the cross-sectional blueprint and diminutive sample size.

The results suggest a potential benefit of office BP and ambulatory BP monitoring used in concert to identify patients with type 1 diabetes who are at risk of developing cardiovascular disease through masked hypertension. 

Disclosures: Multiple authors declare affiliations with the pharmaceutical industry. Please refer to reference for a complete list of authors' disclosures.

Reference

Lithovius R, Gordin D, Forsblom C, Saraheimo M, Harjutsalo V, Groop P-H; on behalf of the FinnDiane Study Group. Ambulatory blood pressure and arterial stiffness in individuals with type 1 diabetes [published online May 24, 2018]. Diabetologia. doi: 10.1007/s00125-018-4648-5

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