1786-LB: Twenty-Four-Hour Ambulatory Blood Pressure and Vascular Complications in Type 1 Diabetes Subjects—Systematic Review and Meta-analysis of Prospective Studies

Introduction & Objective: Office blood pressure (BP) measures may not identify early changes in BP that may indicate risk of development or progression of complications in diabetic individuals. The 24hour ambulatory blood pressure (ABP) offers more BP measures, including sleeping time. Our objective was to evaluate the ABP as a predictor of vascular outcomes in office normotensive patients with type 1 diabetes subjects (T1D) over time.

Methods: Systematic review with meta-analysis at Embase, PubMed/Medline and Web of Science database including cohort studies in normotensive T1D patients underwent to ABP at baseline and subsequent evaluation of vascular complications during follow-up. Measurements of difference (mmHg) were obtained using a random effect model for each variable of ABP (systolic and diastolic BP - day, night and 24h).

Results: Only 7 out of 364 articles were included, 635 participants were evaluated, age 25.8±6.2 years, 57% male, diabetes duration 11.8±5.3 years, HbA1c 8.5%±1.6, over 4.2 years. Lower nighttime systolic BP -4.37 mmHg (95%CI -6.96;-1.79, p0.0009, I²30%) and nighttime diastolic BP-3.97 mmHg (95%CI -5.85;-2.10, p <0.0001, I²0%,) at baseline were associated to renal protection. Lower nighttime diastolic BP -3.62 mmHg (95%CI -7.18;-0.06, p0.042, I²0%), daytime diastolic BP -2.69 mmHg (95%CI -4.84;-0.55, p0.0138, I²0%) and 24h diastolic BP -3.65 mmHg (95%CI -6.56;-0.75, p0.037, I²0%) were associated with better ocular outcomes. Macrovascular and neuropathy outcomes were not found.

Conclusion: In T1D patients lower nocturnal BP values ​​were associated with better microvascular outcomes. The office BP would not be able to identify these cases. ABP should be included in the care of patients with diabetes.