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Table of Contents
REVIEW ARTICLE
Year : 2022  |  Volume : 19  |  Issue : 2  |  Page : 126-128

Factors contribute to elevated blood pressure values in children with type 1 diabetes mellitus: A review


Paediatric Department, College of Medicine, Al-Mustansiriyah University, Baghdad, Iraq

Date of Submission08-Apr-2022
Date of Acceptance27-Apr-2022
Date of Web Publication30-Jun-2022

Correspondence Address:
Wasnaa Hadi Abdullah
Paediatric Department, College of Medicine, Al-Mustansiriyah University, Baghdad
Iraq
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/MJBL.MJBL_58_22

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  Abstract 

Hypertension is common in children with type 1 diabetes mellitus. Although the exact prevalence of hypertension in pediatric patients with diabetes mellitus is unknown, many studies show rates ranging from 6% to 16%. Several studies looked at the variables that impact blood pressure levels in type 1 diabetes. However, articles in pediatric age group are limited. Upon reviewing the recently published articles, the factors which found to have a significant relationship with blood pressure readings in children with type 1 diabetes mellitus are as follows: patient age, gender, body composition, total fat percentage, body mass index, diabetes duration, glycated hemoglobin levels, and diabetic nephropathy.

Keywords: Children, diabetes, hypertension


How to cite this article:
Akram NN, Abdullah WH, Ibrahim BA. Factors contribute to elevated blood pressure values in children with type 1 diabetes mellitus: A review. Med J Babylon 2022;19:126-8

How to cite this URL:
Akram NN, Abdullah WH, Ibrahim BA. Factors contribute to elevated blood pressure values in children with type 1 diabetes mellitus: A review. Med J Babylon [serial online] 2022 [cited 2022 Oct 7];19:126-8. Available from: https://www.medjbabylon.org/text.asp?2022/19/2/126/349489




  Introduction Top


Hypertension is one of the most common chronic health problems around the globe, and it’s a well-known and controllable cause of cardiovascular disease and death.[1] Patients with diabetes mellitus (DM) are more likely to have hypertension.[2] Hypertension is common in children with type 1 diabetes (T1DM). Although the exact prevalence of hypertension in pediatric patients with DM is unknown, many studies show rates ranging from 6% to 16%. The prevalence was affected by age and rose among Asian Pacific Islander and American Indian children, but gender was not significantly different.[3],[4],[5] In a study done in the US, children with even a single raised blood pressure measurement were found to have a higher chance of acquiring hypertension than adults.[6] For many important reasons, it is critical to identify and manage hypertension in children with type 1 diabetes. Furthermore micro- and macrovascular complications can be prevented in diabetic children by controlling hypertension.[7] Lower blood pressure objectives, preferably 130/80 mm Hg, have been advocated by consensus recommendation committees.[8] Despite the recommendations, hypertension in children with T1DM is still not properly recognized and treated as much as required.[9],[10] This can be attributed to poor screening,[4] the need for repeated measurements, which can lead to delayed diagnosis,[11] and inconvenience with prescribing anti-hypertensive medications in pediatrics.[12]


  Factors Contribute to Elevated Blood Pressure Value in Children With T1DM Top


The effects of body mass index (BMI) on blood pressure in diabetic children have been extensively studied. Daymen et al.[12] and Pietrzak et al.[13] show a positive correlation between BMI and hypertension in children with T1DM. Overweight and obesity are defined by an excess of total body mass combined with an excess of fat mass. Body fat is now recognized as not just a source of energy but also a very active secreting organ. Adipokines are hormones produced by fat tissue that have a role in insulin sensitivity modulation.[14] Insulin resistance causes arteriosclerosis, which leads to cardiovascular disease, when combined with hyperglycemia, dyslipidemia, and hypertension.[15]

Body composition as a factor linked to increased blood pressure in diabetic patients was investigated by Daymen et al. The body composition which expressed as percentage of each of the followings (Total fat mass, lean body mass, soft tissue fat mass, fat / lean ratio, and abdomen fat and trunk fat) measured by Dual energy X-ray absorptiometry (DEXA) found to have significant effect on development of hypertension in T1DM. Daymen et al. found that abdominal fat percent was the only parameter strongly and significantly related to mean arterial blood pressure and systolic blood pressure (SBP) in the diabetic patients, while diastolic blood pressure (DBP) was affected by abdominal fat %, duration of diabetes and fat/lean ratio in addition to abdominal fat percent.[12] Both Drożdż et al.[16] and Eisenmann et al.[17] found that an increase in body fat mass in healthy children resulted in increased values of both systolic and diastolic blood pressure.

High levels of glycated hemoglobin (HbA1c) may be associated with increased blood pressure in pediatric patients with T1DM. De Oliveira et al. in a descriptive study involved 60 children and adolescents with an established diagnosis of T1DM demonstrated a positive relation of elevated HbA1c levels and development of prehypertension, in their study each 1% increase in HbA1c is associated with an increase of 1.73 mmHg in diastolic blood pressure (DBP).[18] However, Pietrzak et al. found no association between metabolic control as estimated by HbA1c and blood pressure values.[13] An elevated HbA1c levels which reflect poor glycemic control and hyperglycemia had adverse effect on vascular wall function and structure. The consequences of hyperglycemia on the vascular wall have been well documented in the literatures. Hyperglycemia can contribute to the onset of hypertension. Vasoconstriction (through changes in endothelin and nitric oxide) and extracellular matrix deposition can occur as a result of elevated levels of advanced glycation end products, reactive oxygen species, and sorbitol. Protein kinase C activation might be crucial in these processes.[19],[20]

In addition, elevated HbA1c levels are strongly linked to microvascular problems, such as diabetic nephropathy, which carries a high risk of cardiovascular disease.[21],[22] Microalbuminuria has been linked to greater diastolic blood pressures, whereas better glycemic management (HbA1c less than 7.5%) has been linked to a lower risk of microalbuminuria.[23]

Furthermore, a positive correlation between DBP and diabetes duration was found by Pietrzak et al. with no significant association with systolic blood pressure.[13] With regards to gender, lower systolic blood pressure values were observed among girls than boys, diastolic blood pressure values were comparable in both sexes.[13]

Regarding diabetic nephropathy, prehypertension and hypertension are more prevalent in diabetic patients with microalbuminuria, this is in agreement with studies conducted by Amritanshu et al.,[24] who found that development and progression of microalbuminuria is closely linked to hypertension. However; Omar et al.’s [25] study found no significant difference in the prevalence of hypertension between diabetic patients with or without microalbuminuria. On the contrary, in their study, Rönnback et al.[26] found that type 1 diabetic patients had a greater pulse pressure that increases earlier and more rapidly than the nondiabetic background group, even in the absence of diabetic kidney damage.


  Conclusions Top


Hypertension in children with T1DM is likely to be more common than previously thought. Blood pressure changes in type 1 diabetes raise the risk of microvascular and macrovascular problems. Several studies looked into the factors that influence blood pressure levels in type 1 diabetes children and adolescents. The age, gender, body composition, total fat percentage, BMI, diabetes duration, glycated hemoglobin (HbA1c) levels, and diabetic nephropathy in type 1 diabetic patients were all found to have a significant relationship with high blood pressure.

Ethical consideration

Not applicable.

Acknowledgement

To our university Al-Mustansiriyah, for the continuous support.

Financial support and sponsorship

This work was self-funded.

Conflicts of interest

There are no conflicts of interest.



 
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Margeirsdottir HD, Larsen JR, Brunborg C, Overby NC, Dahl-Jørgensen K; Norwegian Study Group for Childhood Diabetes. High prevalence of cardiovascular risk factors in children and adolescents with type 1 diabetes: A population-based study. Diabetologia 2008;51:554-61.  Back to cited text no. 3
    
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Rodriguez BL, Dabelea D, Liese AD, Fujimoto W, Waitzfelder B, Liu L, et al; SEARCH Study Group. Prevalence and correlates of elevated blood pressure in youth with diabetes mellitus: The SEARCH for diabetes in youth study. J Pediatr 2010;157:245-51.e1.  Back to cited text no. 4
    
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Berenson GS Childhood risk factors predict adult risk associated with subclinical cardiovascular disease. The Bogalusa heart study. Am J Cardiol 2002;90:3L-7L.  Back to cited text no. 7
    
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Nambam B, DuBose SN, Nathan BM, Beck RW, Maahs DM, Wadwa RP, et al; T1D Exchange Clinic Network. Therapeutic inertia: Underdiagnosed and undertreated hypertension in children participating in the T1D exchange clinic registry. Pediatr Diabetes 2016;17:15-20.  Back to cited text no. 10
    
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Steigleder-Schweiger C, Rami-Merhar B, Waldhör T, Fröhlich-Reiterer E, Schwarz I, Fritsch M, et al. Prevalence of cardiovascular risk factors in children and adolescents with type 1 diabetes in Austria. Eur J Pediatr 2012;171:1193-202.  Back to cited text no. 11
    
12.
Downie ML, Ulrich EH, Noone DG An update on hypertension in children with type 1 diabetes. Can J Diabetes 2018;42:199-204.  Back to cited text no. 12
    
13.
Pietrzak I, Mianowska B, Gadzicka A, Młynarski W, Szadkowska A Blood pressure in children and adolescents with type 1 diabetes mellitus–the influence of body mass index and fat mass. Pediatr Endocrinol Diabetes Metab 2009;15:240-5.  Back to cited text no. 13
    
14.
Rasouli N, Kern PA Adipocytokines and the metabolic complications of obesity. J Clin Endocrinol Metab 2008;93:S64-73.  Back to cited text no. 14
    
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Abd El Dayem SM, Battah AA Hypertension in type 1 diabetic patients-the influence of body composition and body mass index: An observational study. Anadolu Kardiyol Derg 2012;12:60-4.  Back to cited text no. 15
    
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Drozdz D, Kwinta P, Korohoda P, Pietrzyk JA, Drozdz M, Sancewicz-Pach K Correlation between fat mass and blood pressure in healthy children. Pediatr Nephrol 2009;24:1735-40.  Back to cited text no. 16
    
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Eisenmann JC, Sarzynski MA, Glenn K, Rothschild M, Heelan KA ACE I/D genotype, adiposity, and blood pressure in children. Cardiovas Diabetol 2009;8:1-8.  Back to cited text no. 17
    
18.
de Oliveira S, da Cunha Nascimento D, Tibana RA, de Oliveira SL, de Sousa Neto IV, Falleiros RK, et al. Elevated glycated hemoglobin levels impair blood pressure in children and adolescents with type 1 diabetes mellitus. Diabetol Metab Syndr 2016;8:4.  Back to cited text no. 18
    
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Brownlee M The pathobiology of diabetic complications: A unifying mechanism. Diabetes 2005;54:1615-25.  Back to cited text no. 19
    
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Orchard TJ, Forrest KY, Kuller LH, Becker DJ; Pittsburgh Epidemiology of Diabetes Complications Study. Lipid and blood pressure treatment goals for type 1 diabetes: 10-year incidence data from the Pittsburgh epidemiology of diabetes complications study. Diabetes Care 2001;24:1053-9.  Back to cited text no. 21
    
22.
Fullerton B, Jeitler K, Seitz M, Horvath K, Berghold A, Siebenhofer A Intensive glucose control versus conventional glucose control for type 1 diabetes mellitus. Cochrane Database Syst Rev 2014;2:3-24.  Back to cited text no. 22
    
23.
Laffel LM, McGill JB, Gans DJ The beneficial effect of angiotensin-converting enzyme inhibition with captopril on diabetic nephropathy in normotensive IDDM patients with microalbuminuria. North american microalbuminuria study group. Am J Med 1995;99:497-504.  Back to cited text no. 23
    
24.
Amritanshu K, Kumar A, Anand K Clinical profile and factors associated with microalbuminuria in type 1 diabetes mellitus in children and adolescents. Int J Res Med Sci 2015;3:1247-51.  Back to cited text no. 24
    
25.
Omar MA, Rezk MM, El-Kafoury AA, Kandil MS Microalbuminuria and glycated hemoglobin in children with type 1 diabetes mellitus. Alexandr J Med 2015;51:83-8.  Back to cited text no. 25
    
26.
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