Endocrine Abstracts

Objective: To evaluate changes of ambulatory blood pressure monitoring (ABPM) parameters in normotensive and normoalbuminuric patients with type 1 diabetes (TDM1) after 7 years.

Methods: A longitudinal study conducted in normotensive and normoalbuminuric patients with TDM1. ABPM (Spacelabs 90217) basal was performed. Altered ABPM was considered when: i) Mean systolic pressure (sBP) was ≥130 mmHg in the 24 h and daytime periods and ≥120 mmHg in the night-time period and/or mean diastolic pressure (dBP) ≥80 or 70 mmHg in the same periods respectively, and/or ii) more than 50% of the readings were higher than the defined previous criteria, and/or iii) nocturnal fall in either sBP or dBP was lower than 10% (non-dippers). Patients meeting criteria 1 or 2 were considered hypertensives and treated with an ACE inhibitor (Enalapril). Patients were reevaluated after 7 years.

Results: Sixty-nine patients (52.2% women) were included, aged 28.3±6.1 years and 11.4±6.2 years of diabetes evolution. 17 patients (24.6%) were diagnosed as hipertensive and were treated. No clinical differences were detected between groups (age, diabetes evolution, BMI, and HbA1c). After 7 years there was a significant improvement in mean daytime sBP (from 131.4 ± 8.8 to 124.4 ± 10.9 mmHg, P<0.001) and night-time sBP (from 113.6 ± 11.8 to 108.4 ± 10.5 mmHg, P<0,001) among treated patients. Among basal normotensive patients, although no relevant changes were detected in ABPM parameters, four patients (7.7%) developed hypertension. No differences in retinopathy or nephropathy prevalence were detected between groups in the basal and final evaluation.

Conclusions: In our study, treatment with ACE inhibitors improves ABPM parameters in hypertensive patients; normotensive patients rarely progress to hypertension after 7 years of evolution.