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(Circulation. 2004;110:1076-1082.)
© 2004 American Heart Association, Inc.

Original Articles

Altered Age-Related Blood Pressure Pattern in Type 1 Diabetes

Mats Rönnback, MD; Johan Fagerudd, MD DMSc; Carol Forsblom, DMSc; Kim Pettersson-Fernholm, MD; Antti Reunanen, MD DMSc; Per-Henrik Groop, MD DMSc, on behalf of the Finnish Diabetic Nephropathy (FinnDiane) Study Group

From the Folkhälsan Research Center (M.R., J.F., C.F., K.P.-F., P.-H.G.), Biomedicum Helsinki; the Department of Medicine (M.R., J.F., C.F., K.P.-F., P.-H.G.), Division of Nephrology, Helsinki University Central Hospital; and the National Public Health Institute (A.R.), Helsinki, Finland.

Correspondence to Per-Henrik Groop, MD, DMSc, Folkhälsan Research Center, Biomedicum Helsinki (C318b), PO Box 63, FIN-00014, University of Helsinki, Helsinki, Finland. E-mail per-henrik.groop{at}helsinki.fi

Received October 29, 2003; de novo received February 16, 2004; revision received April 13, 2004; accepted April 14, 2004.

Background— Pulse pressure (PP) increases with age as a result of arterial stiffening and is a powerful predictor of cardiovascular disease. Type 1 diabetes is associated with excessive cardiovascular mortality and increased arterial stiffness. We examined whether the age-related blood pressure changes in type 1 diabetic patients differ from those of the nondiabetic background population.

Methods and Results— We performed a cross-sectional, case-control study of 2988 consecutively selected diabetic subjects and 5486 randomly selected nondiabetic control subjects. Blood pressure was measured twice by mercury sphygmomanometry on a single occasion. Compared with controls, diabetic subjects had a higher systolic blood pressure in all age groups, whereas diastolic blood pressure was higher in those <40 years but lower in those >45 years of age. Consequently, diabetic subjects had a higher PP and a higher prevalence of isolated systolic hypertension. The early age-related rise in PP was more pronounced in subjects with diabetic nephropathy but was also evident in diabetic subjects with normal albumin excretion rate. In a multiple regression analysis, PP in diabetic patients was associated with age, male sex, duration of diabetes, and albuminuria.

Conclusions— A higher systolic pressure and an earlier decrease in diastolic pressure result in a higher and more rapidly increasing PP in type 1 diabetic patients. Our findings indicate accelerated arterial aging, which may contribute to the higher cardiovascular morbidity and mortality in these patients.

Key Words: aging • arteriosclerosis • blood pressure • diabetes mellitus • hypertension

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