Bromocriptine Improves Central Aortic Stiffness in Adolescents With Type 1 Diabetes: Arterial Health Results From the BCQR-T1D Study

• Published in: Hypertension (Dallas, Tex. 1979) Vol. 80; no. 2; pp. 482 - 491
• Main Authors: Schäfer, Michal, Browne, Lorna P., Truong, Uyen, Bjornstad, Petter, Tell, Shoshana, Snell-Bergeon, Janet, Baumgartner, Amy, Hunter, Kendall S., Reusch, Jane E.B., Barker, Alex J., Nadeau, Kristen J., Schauer, Irene E.
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 01-02-2023
• Subjects: Adolescent; Bromocriptine; Cross-Over Studies; Diabetes Mellitus, Type 1 - complications; Diabetes Mellitus, Type 1 - drug therapy; Humans; Pulse Wave Analysis; Vascular Stiffness - physiology; bromocriptine; stiffness; hypertension; hemodynamics; pediatrics
• ISSN: 0194-911X; 1524-4563
• DOI: 10.1161/HYPERTENSIONAHA.122.19547

The presence of vascular dysfunction is a well-recognized feature in youth with type 1 diabetes (T1D), accentuating their lifetime risk of cardiovascular events. Therapeutic strategies to mitigate vascular dysfunction are a high clinical priority. In the bromocriptine quick release T1D study (BCQR-T1D), we tested the hypothesis that BCQR would improve vascular health in youth with T1D.
BCQR-T1D was a placebo-controlled, random-order, double-blinded, cross-over study investigating the cardiovascular and metabolic impact of BCQR in T1D. Adolescents in the BCQR-T1D study were randomized 1:1 to phase-1: 4 weeks of BCQR or placebo after which blood pressure and central aortic stiffness measurements by pulse wave velocity, relative area change, and distensibility from phase-contrast magnetic resonance imaging were performed. Following a 4-week washout period, phase 2 was performed in identical fashion with the alternate treatment.
Thirty-four adolescents (mean age 15.9±2.6 years, hemoglobin A1c 8.6±1.1%, body mass index percentile 71.4±26.1, median T1D duration 5.8 years) with T1D were enrolled and had magnetic resonance imaging data available. Compared with placebo, BCQR therapy decreased systolic (∆=-5 mmHg [95% CI, -3 to -7];
<0.001) and diastolic blood pressure (∆=-2 mmHg [95% CI, -4 to 0];
=0.039). BCQR reduced ascending aortic pulse wave velocity (∆=-0.4 m/s;
=0.018) and increased relative area change (∆=-2.6%,
=0.083) and distensibility (∆=0.08%/mmHg;
=0.017). In the thoraco-abdominal aorta, BCQR decreased pulse wave velocity (∆=-0.2 m/s;
=0.007) and increased distensibility (∆=0.05 %/mmHg;
=0.013).
BCQR improved blood pressure and central and peripheral aortic stiffness and pressure hemodynamics in adolescents with T1D over 4 weeks versus placebo. BCQR may improve aortic stiffness in youth with T1D, supporting future longer-term studies.