Endocrine Abstracts

Introduction: The objective is to evaluate the relationship between early blood pressure alterations (detected by ambulatory blood pressure monitoring (abpm)) and the development/progression of retinopathy in patients with type 1 diabetes clinically normotensive.

Methods: We designed a prospective observational study of 85 patients, clinically normotensive and without microalbuminuria, monitored over 7 years. Abpm was performed over 24 h and subclinical hypertension was considered if: i) mean systolic pressure (sbp) was >130 mmHg in the 24 h and daytime periods and >120 mmHg in the nighttime 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. Non dipper pattern was defined as nocturnal sbp or dbp <10% relative to the diurnal mean value. We evaluated the development or progression of retinopathy during the following period.

Results: Of the 85 patients included in the analysis, 55.3% (n: 47) were women with an average age of 27.9±6.1 years and a length of disease of 12.3±6.5 years. 23.5% were diagnosed with subclinical hypertension and 36% with non-dipper pattern as the only pathological finding. 69 patients completed the seven-year follow-up. During this period, 31.8% presented development or progression of retinopathy. Initial mean nocturnal dbp (OR: 1.122, P: 0.034), waist perimeter (OR: 1.075, P: 0.028), and final non-dipper pattern (OR: 5.857, P: 0.005) showed as independent risk factors of progression/development of retinopathy.

Conclusions: In type 1 diabetic patients clinically normotensive there is a high prevalence of blood pressure alterations detected by abpm. Nocturnal blood pressure parameters predisposes the development or progression of retinopathy.