VARIABILITY OF ARTERIAL BLOOD PRESSURE IN CHILDREN WITH DIABETES MELLITUS AND OBESITY
Abstract
INTRODUCTION: The activity of the cardiovascular system has a clear to the circadian rhythms of a child's body. Daily fluctuations in blood pressure in normal conditions and in pathology is a physiological phenomenon which can play a significant role in developing arterial hypertension and even in the occurrence of fatal cardiovascular states such as heart attacks, strokes, and sudden cardiac arrest activities. Ambulatory blood pressure monitoring is recognized as a necessary instrumental investigation for diagnosis and management of patients with arterial hypertension and especially in children from high risk groups such as diabetics and obesity it may be even more important for hypertension diagnostics than in adults.
AIM: The objective of the study was to analyze the features of circadian oscillations of blood pressure and heart rate variability in children with diabetes mellitus and hypothalamic syndrome with obesity.
METHODS: Research included 76 children aged 10 to 18 years: 52 children with endocrine pathology (diabetes and obesity) and 24 clinically healthy persons. The peculiarities of nutrition, sleep, and the definition of the chronotype using the Horn-Ostberg questionnaire were carried out. The functional state of the cardiovascular systems was determined by single office measurement and by ambulatory blood pressure monitoring.
FINDINGS AND RESULTS: Ambulatory blood pressure monitoring revealed a number of differences between the groups of children. In diabetic patients, daytime systolic blood pressure was higher with increased variability, while the night blood pressure was significantly lower and with significantly less variability, compared to other groups. Attention is drawn to the higher level of diastolic blood pressure and lower variability at night in obese children.
CONCLUSIONS: Daily fluctuations of arterial pressure in children with diabetes and obesity differ from healthy persons depending on the type of disease and could be regarded as result of circadian biorhythms disruption. In obese persons it appears in the form of nocturnal SBP and DBP elevation but with index of variability compared to the control group. In diabetic children the circadian BP rhythms deviations appear in form of SBP elevation during the day with higher index of its variability. Their BP changes were associated with the presence of diabetic nephropathy and proteinuria.
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