Ambulatory blood pressure abnormalities and arterial stiffness in children with type 1 diabetes: the role of pulse wave velocity

BACKGROUND: Children with type 1 diabetes mellitus (T1DM) are at increased risk of early cardiovascular alterations, including hypertension and arterial stiffness. This study aimed to evaluate ambulatory blood pressure monitoring (ABPM) patterns, arterial stiffness parameters, and factors associated with ambulatory hypertension and arterial stiffness in children with T1DM. METHODS: In this cross-sectional study, 60 children with T1DM (mean age 13.36 ± 3.38 years) and 32 healthy controls underwent 24-h ABPM and pulse wave analysis. Blood pressure variability (BPV) was quantified using average real variability. Clinical, laboratory, and metabolic parameters were recorded. RESULTS: Children with T1DM had significantly higher 24-h peripheral systolic and diastolic blood pressure standard deviation score (SDS), mean arterial pressure SDS, 24-h central diastolic blood pressure, and higher 24-h and daytime diastolic BPV compared with controls (all p ≤ 0.002). Pulse wave velocity (PWV)-related measures were also higher, including 24-h pulse wave velocity (PWV) (4.60 vs. 4.40 m/s, p = 0.011) and 24-h PWV SDS (- 0.32 vs. - 0.95, p = 0.001). Compared with healthy controls, normotensive children with T1DM showed only higher nighttime PWV SDS (p = 0.004), accompanied by a trend toward higher nighttime blood pressure parameters, whereas 24-h and daytime PWV and PWV SDS were similar between the groups (p > 0.05). Compared with normotensive children with T1DM, those with ambulatory hypertension had significantly higher central blood pressure, PWV, and PWV SDS across all time periods (all p < 0.05). Ambulatory hypertension was detected in 38.3% of patients with T1DM, of whom 82.6% had masked hypertension. Compared with normotensive diabetic children, those with ambulatory hypertension had higher central blood pressure, PWV, PWV SDS, and nighttime diastolic BPV (all p < 0.05). In multivariable logistic regression analysis, age (OR 1.47, 95% CI 1.12-1.92, p = 0.005) and 24-h PWV SDS (OR 6.40, 95% CI 2.20-18.64, p = 0.001) were independently associated with ambulatory hypertension. Isolated nocturnal hypertension (18.3%) was also associated with higher 24-h PWV SDS. In linear regression analysis, ambulatory hypertension was the strongest independent association with 24-h PWV SDS, followed by male sex and higher BMI z-score, while increasing age was independently associated with lower 24-h PWV SDS, and HbA1C and diabetes duration were not associated. CONCLUSIONS: Children with T1DM exhibited increased ambulatory blood pressure abnormalities, vascular and hemodynamic alterations, and higher diastolic BPV compared with healthy controls. Masked and particularly isolated nocturnal hypertension were highly prevalent, underscoring the importance of ABPM in this population. Although normotensive children with T1DM showed only subtle PWV-related abnormalities that paralleled a trend toward higher nocturnal blood pressure parameters, the most pronounced PWV abnormalities were observed in children with ambulatory hypertension, suggesting that PWV changes are more closely related to blood pressure abnormalities than to the diagnosis of T1DM itself. Further longitudinal studies are needed to clarify the clinical significance of these findings.