Ambulatory blood pressure monitoring and vascular complications in patients with type 1 diabetes mellitus – Systematic review and meta-analysis of observational studies

Aims

This study aimed to evaluate the role of the 24-Hour Ambulatory Blood Pressure Monitoring (ABPM) as a possible predictor of vascular outcomes in office normotensive people with type 1 diabetes mellitus (T1DM).

Methods

This is a systematic review including cohort studies from the Embase, PubMed/Medline, and Web of Science databases on people with T1DM undergoing ABPM and subsequent evaluation of vascular complications. Measurements of difference (MD) were obtained using random effect model meta-analysis.

Results

We found 364 articles and 49 duplicates. Seven studies were included, comprising 635 participants aged 25.8 ± 6.2 years. Most (57.5 %) were men, mean duration of diabetes was 11.8 ± 5.3 years, mean glycated hemoglobin level among participants was 8.5 % ± 1.6 %, and mean follow-up time was 4.2 years. Lower night systolic blood pressure MD − 4.37 mmHg (p = 0.0009) and night diastolic blood pressure MD − 3.97 mmHg (p < 0.0001) were associated with lower incidence of albuminuria. People with T1DM who presented no beginning or progression of retinopathy were those with lower night diastolic blood pressure MD − 3.62 mmHg (p = 0.042), diurnal diastolic blood pressure MD − 2.69 mmHg (p = 0.0138), and 24-hour diastolic blood pressure MD − 3.65 mmHg (p = 0.037).

Conclusion

Small mean differences in blood pressure parameters, as measured by ABPM, between people with T1DM are associated with a lower incidence or risk of progression of nephropathy and retinopathy.