Endocrine Abstracts

Introduction: In preliminary results of our group, we detected an association between the mean nocturnal blood pressure and development microvascular complications. The objective was to evaluate possible nocturnal blood pressure cut off points in relation to the development or progression of retinopathy, microalbuminuria and arterial hypertension in type 1 diabetic patients.

Methods: We designed a prospective observational study of 85 patients, clinically normotensive and without microalbuminuria, monitored over 7 years. We performed a 24 h-ambulatory blood pressure monitoring (ABPM) at the beginning and after 7 years. We evaluated the development/progression of retinopathy and development of microalbuminuria and established hypertension over the follow up period. We analyzed different ranges of nocturnal systolic blood pressure (SBP) and diastolic blood pressure (DBP) as independent variables for the development of such complications

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. 69 patients completed 7-year study. After the follow up period, 31.8% presented development/progression of retinopathy, 10.14% developed microalbuminuria and 7.24% of the normotensive patients progressed to established hypertension. Initial nocturnal DBP greater than 65 mmHg showed as a risk factor for the progression of retinopathy and the development of hypertension after 7 years. In spite of the association between the nocturnal SBP and development of microalbuminuria, we did not detect a cut off point from which a significant risk appeared.

Conclusions: In clinically normotensive and normoalbuminuric patients with type 1 diabetes, a nocturnal DBP greater or equal to 65 mmHg is related to the development/progression of retinopathy and the development of established hypertension.