Masked hypertension and its associations with glycemic variability metrics in children and adolescents with type 1 diabe
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ORIGINAL ARTICLE
Masked hypertension and its associations with glycemic variability metrics in children and adolescents with type 1 diabetes Warinpapha Homhuan 1 & Preamrudee Poomthavorn 1 & Witchuri Paksi 1 & Patcharin Khlairit 1 & Arkom Nongnuch 2 & Kwanchai Pirojsakul 1,3 Received: 30 April 2020 / Revised: 7 July 2020 / Accepted: 21 July 2020 # IPNA 2020
Abstract Background Masked hypertension defined as having normal office blood pressure (BP) but hypertension detected by continuous BP monitoring has been observed in children and adolescents with type 1 diabetes (T1D). However, no study has evaluated whether masked hypertension is associated with glycemic variability (GV) in these patients. We hypothesized that masked hypertension might be associated with high GV in patients with T1D. Methods This cross-sectional study performed continuous glucose monitoring (CGM) in parallel with ambulatory blood pressure monitoring (ABPM) in T1D patients aged 6–21 years. Patients who had known hypertension were excluded. CGM data from the same day as ABPM was calculated for GV including standard deviation (SD), coefficient of variation (CV) of glucose levels, and unstable glycemia which was defined as having a CV of glucose levels ≥ 36%. Results Thirty-three patients had complete ABPM and CGM data. Mean (SD) age was 13.8 (3.8) years and mean (SD) duration of T1D was 5.4 (3.6) years. All patients had normal office BP, but ABPM showed masked hypertension in 9 patients (27%). In comparison with normotensive patients, patients with masked hypertension had longer duration of T1D (7.4 vs. 4.6 years, p = 0.049), higher insulin requirement (1.2 vs. 0.9 units/kg/day, p = 0.049), and higher SD of glucose (70.3 vs. 47.9 mg/dl, p = 0.038). Masked hypertension group had a greater number of patients (71% vs. 19%, p = 0.02) with unstable glycemia. Multivariate analysis revealed that unstable glycemia was associated with masked hypertension. Conclusions The presence of unstable glycemia in children and adolescents with T1D is associated with masked hypertension.
Keywords Masked hypertension . Diabetes mellitus . Children . Continuous glucose monitoring . Ambulatory blood pressure monitoring
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00467-020-04720-2) contains supplementary material, which is available to authorized users. * Kwanchai Pirojsakul [email protected] 1
Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
2
Department of Internal Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
3
Division of Nephrology, Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Type 1 diabetes (T1D) is one of the most common endocrine disorders in children. Metabolic abnormalities of T1D are characterized by hyperglycemia and increased free fatty acid, which induce oxidative stress [1]. Moreover, decreased production of nitric oxide and increase
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