Abnormal diastolic blood pressure and heart rate reactions to tilting in diabetes mellitus

Sundkvist, Göran; Lilja, B.; Almér, Lars‐Olof

doi:10.1007/bf00281822

Cited by 105 publications

(79 citation statements)

References 17 publications

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“…Although we have concluded that cardiac autonomic alterations in diabetic neuropathy preferentially affects parasympathetic nerves, the parasympathetic neuropathic damage may not be distinct in other organs. Indeed, sympathetic neuropathies in the pupil 30 and peripheral nerves 31 were predominant in DM patients. Further study is needed to identify the effect of diabetic neuropathy not only on HRV but also on coronary artery tone for the purpose of early detection of neuroangiopathy, otherwise known as asymptomatic ischemia.…”

Section: Discussionmentioning

confidence: 99%

Inhomogeneous Derangement of Cardiac Autonomic Nerve Control in Diabetic Rats.

Sanyal

Arita

Ono

2002

Circ J

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bnormalities of the function of the autonomic nervous system are frequent and often serious complications in patients with diabetic mellitus (DM), 1 and may be exacerbated by cardiovascular dysfunction. Power spectral analysis of heart rate (HR) variability (HRV) has been shown to be a quantitative and non-invasive method for assessing the effects of the sympathetic and parasympathetic components of autonomic nervous activity of the cardiovascular system. 2 Power spectral analysis of HRV is also a powerful tool for determinating the autonomic nerve tone in patients with diabetic neuropathy, and fast Fourier transform is statistically more robust. 3 However, time domain measurement of the RR intervals is a possible weakness and bottleneck, 4 so we decided to measure frequency domain (power spectral analysis) alternatively with the time domain of RR intervals in order to investigate autonomic nervous function in rats. A telemetric monitoring system for ECG has been developed for small animals and, moreover, sophisticated software permits analysis of HRV for long-term ECG recording even for species with a rapid heart beat. Therefore, analysis of HRV in rats can provide specific information concerning the autonomic nervous activity underlying control of the cardiovascular system in diabetic conditions without any effects of anesthetic agents or changes in environment. Methods Animals and HousingThe study animals were 6 spontaneously diabetic male Circulation Journal Vol.66, March 2002Kob rats, 15-19 months old and weighing 300-320 g, and 9 male Wistar rats of the same age. All rats were purchased from Seac Yoshitomi Limited Ltd (Tokyo, Japan) and were cared for humanely in accordance with the Principles of Laboratory Animal Care formulated by the National Society for Medical Research and the Guide for the Care and Use of Laboratory Animals published by the National Institute of Health (NIH publication No. 85-23, revised 1996). The rats were housed in individual cages with wood shavings in a light-proof room (TB181 or TB182; National, Osaka, Japan) under a light -dark cycle (LD 12:12; lights on at 08.00 h) that was maintained under constant temperature (24°C). The animals had free access to water and a standard diet. The diabetic state of the Kob rats was confirmed by the cardinal symptoms of loss of body weight, polydipsia, polyuria, polyphagia, cataract, increased fasting blood sugar (FBS) and ruffled hair. Surgical ProcedureAnimals were anesthetized with 50 mg/kg of intraperitoneal pentobarbital and a telemetric ECG radio-transmitter (25×15×9 mm in size and 7 g in weight; TA11CTA-F40, Data Sciences International, St. Paul, MN, USA), was placed in a dorsal subcutaneous pouch. The paired wire electrodes for the pericardial bipolar leads (apex-base leads) were placed under the skin of the dorsal and ventral thorax and the skin was sutured. ECG records were initiated 3 days after surgery to avoid any possible effects of residual anesthetic or the surgery. ECG Recordings and Data AnalysesEach rat cage was placed on top...

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Section: Discussionmentioning

confidence: 99%

Inhomogeneous Derangement of Cardiac Autonomic Nerve Control in Diabetic Rats.

Sanyal

Arita

Ono

2002

Circ J

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“…Autonomic nerve function was assessed from the heart rate reactions to deep breathing (expiration/inspiration ratio, a test of parasympathetic nerve function) [26] and to tilt (acceleration and brake indices, tests considering sympathetic nerve function as well) [27]. The blood pressure reaction to tilt was also assessed as a test of sympathetic nerve function.…”

Section: Subjects Materials and Methodsmentioning

confidence: 99%

Glutamic acid decarboxylase antibodies, autonomic nerve antibodies and autonomic neuropathy in diabetic patients

Sundkvist¹,

Velloso²,

K�mpe³

et al. 1994

Diabetologia

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SummaryTo clarify whether GAD-ab are associated with diabetic autonomic neuropathy and/or complement fixing antibodies against sympathetic ganglia, adrenal medulla, and vagus nerve, we examined 133 diabetic patients (95 with IDDM). GAD-ab were determined by a radioligand binding assay using in vitro expression of recombinant GAD-65 whereas sympathetic ganglia antibodies, adrenal medulla antibodies, vagus nerve, and ICA were evaluated by indirect immunofluorescence assays. Autonomic nerve function was evaluated by objective tests (heart rate reactions to deep breathing and to tilt). In the total material of 133 patients, GAD-ab were detected in 36 patients, all of whom had IDDM. The frequency of GADab was similar (38 %) in IDDM patients with and without signs of autonomic neuropathy (21 of 55 vs 15 of 40). In addition, there were no significant associations between GAD-ab and autonomic nerve antibodies; GAD-ab were detected in 9 of 21 (43 %) of patients with and in 27 of 112 (24 %) of patients without sympathetic ganglia antibodies, in 5 of 15 (33 %) of patients with and 31 of 118 (26 %) without adrenal medulla antibodies, and in 5 of 15 (33 % ) with and 31 of 118 (26 %) of patients without vagus nerve antibodies. The frequency of ICA, however, was significantly increased in patients with sympathetic ganglia antibodies compared with those without sympathetic ganglia antibodies (10 of 21 [48 %] vs 21 of 112 [19 %];p < 0.01). In conclusion, GAD-ab were neither associated with disturbed autonomic nerve function nor with antibodies against autonomic nerve structures. [Diabetologia (1994) 37: 293-299]

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“…After 20 minutes at three different angles, the response was the same: a drop of BP and an increase in HR by more than 70% [25]. Another study guaranteed that 30 minutes of tilt and an angle of 60 degrees represent the best available resource to investigate the blood pressure fall [21,23].…”

Section: Discussionmentioning

confidence: 92%

A Five-day Orthostatic Training Program Improves Cardiovascular Response in Intensive Care Patients

Tavares¹,

Vega²,

Guimarães³

et al. 2017

Int J Phys Med Rehabil

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Objective: To evaluate the cardiovascular response to passive orthostatic training. Method:Intensive care patients were recruited. Patients in Control group underwent conventional physical therapy. Patients in the Training group additionally underwent daily assistive standing training with the use of an orthostatic bed for five days. All patients in the Training group were evaluated while on the orthostatic table (at rest for 10 minutes, at 75 degrees of inclination for 40 minutes and after returning to the supine position). Heart rate and mean arterial pressure were assessed at each stage. Both groups were assessed at baseline and after seven days. Results:After the 5-day intervention patients from Control group had their mean arterial pressure decreased significantly (19 mmHg in average) when compared to baseline mean arterial pressure at the moment they had their body position elevated, with the worsening of postural hypotension in the following minutes, pattern which not found in the Training group patients. Conclusion:A five-day orthostatic training in intensive care patients can be safely performed and improves cardiovascular response.

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Abnormal diastolic blood pressure and heart rate reactions to tilting in diabetes mellitus

Cited by 105 publications

References 17 publications

Inhomogeneous Derangement of Cardiac Autonomic Nerve Control in Diabetic Rats.

Inhomogeneous Derangement of Cardiac Autonomic Nerve Control in Diabetic Rats.

Glutamic acid decarboxylase antibodies, autonomic nerve antibodies and autonomic neuropathy in diabetic patients

A Five-day Orthostatic Training Program Improves Cardiovascular Response in Intensive Care Patients

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