ReviewAn Update on Hypertension in Children With Type 1 Diabetes
Introduction
Hypertension is 1 of the leading modifiable risk factors in the development of cardiovascular disease worldwide (1). In patients with diabetes, hypertension is even more prevalent than in the general population, and it has been recognized for decades that cardiovascular disease remains a leading cause of morbidity and mortality in adults with type 1 diabetes mellitus 2, 3. The vascular remodelling in type 1 diabetes begins in childhood and is augmented by the presence of hypertension (4), so the identification and appropriate treatment of hypertension in children with type 1 diabetes is paramount to prevent further micro- and macrovascular complications.
It is alarming that the prevalence of hypertension in children with type 1 diabetes has been reported to be between 6% and 16% 5, 6, 7 and, in a recent study in the United States, children with a single elevated blood pressure (BP) measurement were shown to be at increased risk for developing hypertension when they are adults (8). Despite the existence of Canadian guidelines outlining recommended screening frequency for hypertension in children with type 1 diabetes, as well as treatment strategies (9), hypertension in this setting remains underdiagnosed and undertreated overall (10).
In this review, we discuss what is currently known about the epidemiology, pathophysiology, risk factors and management strategies of hypertension in children with type 1 diabetes.
Section snippets
Definition of Hypertension
The current definition of hypertension in children is based on the normative distribution of BP in healthy children, characterized by sex and height, as outlined in the recently updated clinical practice guidelines (Table 1) (11). The Diabetes Canada clinical practice guidelines dictate that children with type 1 diabetes should be treated according to these normative guidelines (9).
Endothelial and vascular dysfunction in type 1 diabetes
The endothelium is important for maintaining normal vascular tone; it is mediated by the secretion of nitric oxide (a vasodilator) and endothelin-1 (a vasoconstrictor) for angiogenesis via the secretion of vascular endothelial growth factor, and it also modulates innate immunity and the coagulation system (26). Endothelial dysfunction occurs when these normal homeostatic properties are altered (26). The Steno hypothesis suggested that albuminuria represented a marker not only for nephropathy
Management
Prevalence studies have repeatedly shown that hypertension is undertreated in patients with type 1 diabetes; this is believed to be a result of reduced or ineffective screening. ABPM is superior to random BP measurement for the prediction of cardiovascular events (78). One of the first signs of hypertensive load is the loss of dipping, the physiologic drop in BP at night, which is identified by ABPM (79).
Conclusions
Hypertension in children with type 1 diabetes is probably more prevalent than has been realized previously, and there may be subtle patterns that would become apparent only with a 24-hour ABPM, patterns such as inadequate nocturnal dip in BP. The mainstay of therapy at present remains diet and glycemic control with ACE inhibition. Future therapeutic strategies might target the preceding endothelial dysfunction, vascular dysfunction or inflammation.
Author Disclosures
Conflicts of interest: None.
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Overview of endocrine hypertension in children
2023, Progress in Pediatric CardiologyCitation Excerpt :Moreover, endothelial and vascular dysfunctions, and increased carotid artery intima-media thickness, are evident in preclinical and clinical studies of children with T1DM [68]. Early targeted therapy is critical to the control of hypertension and the development of related morbidity [66]. Lifestyle modifications remain first-line therapy, including diet and glycemic control [69].
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2022, Canadian Journal of DiabetesCitation Excerpt :Similarly, hypertension is more prevalent in children and youth with T1D than in the general population (43). Early identification and appropriate treatment are critical to prevent the development of micro- and macrovascular complications (44,45). Nevertheless, families in our diabetes clinic were not routinely advised to have BP measurements in preparation for their telemedicine visits.
Bifidobacterium reduction is associated with high blood pressure in children with type 1 diabetes mellitus
2021, Biomedicine and PharmacotherapyCitation Excerpt :Studies have shown that children with T1DM have a higher prevalence of office and ambulatory hypertension (HTN) compared to their healthy counterparts. The prevalence of hypertension in children with T1DM is reported to be between 6% and 16% [3]. Studies have also reported a higher prevalence of abnormalities in 24 h ambulatory BP measurements and patterns in children with T1DM; in fact, BP dipping predicted the risk of future microalbuminuria development [4].
Goodman’s Basic Medical Endocrinology
2021, Goodman's Basic Medical EndocrinologyDiabetes and Hypertension: The Low and High Points
2018, Canadian Journal of Diabetes
The Canadian Diabetes Association is the registered owner of the name Diabetes Canada.
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Co-first authors.