An Update on Hypertension in Children with Type 1 Diabetes

Publication date: Available online 6 March 2018 Source:Canadian Journal of Diabetes Author(s): Mallory L. Downie, Emma Ulrich, Damien G. Noone The prevalence of hypertension in children with T1D is reported to lie between 6-16%. This potentially modifiable cardiovascular risk factor may go undiagnosed and under-treated, particularly in children with T1D. Recent updated Canadian clinical practice guidelines recommend blood pressure screening every 2 years in children with T1D, as well as routine use of ambulatory blood pressure monitoring. Risk factors for hypertension in T1D include poor glycemic control, overweight and obesity, and genetic predisposition for hypertension. In terms of pathophysiology, sustained hyperglycemia, angiotensin I and II, and inflammatory cytokines have been implicated. Endothelial and vascular dysfunction, with impaired endothelial-dependent vasodilation and increased carotid artery intima-media thickness, are evident in preclinical and clinical studies of children and not just in adults with T1D. Early targeted therapy is critical to the control of hypertension and the development of related morbidity. As with hypertension in adults with T1D, lifestyle modifications remain first line therapy, including diet and glycaemic control. Initial anti-hypertensive therapy should be an ACE inhibitor or angiotensin receptor blocker (ARB) due to their associated effects of reduced microalbuminuria and improved renovascular outcomes. Pediatric hypertension...
Source: Canadian Journal of Diabetes - Category: Endocrinology Source Type: research