Ambulatory blood pressures and autonomic nervous function in normoalbuminuric type I diabetic patients.

Ittersum, Frans J. van; Spek, Janneke J.; Praet, I. J. A.; Lambert, J.; IJzerman, Richard G.; Fischer, H. R. A.; Nikkels, R. E.; Bortel, L.M.A.B. Van; Donker, A. J. M.; Stehouwer, Coen D.A.

doi:10.1093/oxfordjournals.ndt.a027826

Cited by 24 publications

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“…41 The higher HR in DM is in accordance with some earlier studies, the reason being unclear. 42 An increased sympathetic tone often accompanies an increase in resting HR. 43 This was not evaluated in the present study, but baseline sympathetic tone has not previously been demonstrated to be higher in uncomplicated type 1 diabetes.…”

Section: Discussionmentioning

confidence: 99%

Long-term hyperglycaemia impairs vascular smooth muscle cell function in women with type 1 diabetes mellitus

Bjarnegård

Arnqvist

Lindström

et al. 2009

Diabetes and Vascular Disease Research

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O bservations of increased stiffness in the elastic aorta in women with diabetes, but not men, emphasise the need for further analysis regarding early abnormalities in arterial wall properties of women with type 1 diabetes mellitus (DM).Ultrasound was used to study the wall properties of the distal brachial artery (BA) in 37 type 1 diabetic women (aged 22-45 years) without evident complications and in 53 controls (C). Blood samples were drawn for later analysis.Flow-mediated dilatation (FMD) was slightly lower in DM than C, 8.1+4.3% vs. 10.3+4.9% (p<0.05), and nitrate-mediated dilatation (NMD) was markedly lower, 21.7+6.6% vs. 31.4+5.7% (p<0.001). Lumen diameter, intima-media thickness and distensibility were similar in DM and C. Insulin-like growth factor (IGF-1) was lower in DM than C, 231+65 vs. 349+68 ng/ml (p<0.001). Glycosylated haemoglobin (HbA 1C ) and matrix metalloproteinase (MMP-9) were independent predictors of the reduced NMD in the DM.Brachial artery responsiveness to an exogenous donor of nitric oxide (NO) was markedly reduced in type 1 diabetic women despite only limited reduction in endotheliumdependent dilatation. The negative association between NMD and HbA 1C suggests that long-term hyperglycaemia impairs vascular smooth muscle cell function in DM.

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Section: Discussionmentioning

confidence: 99%

Long-term hyperglycaemia impairs vascular smooth muscle cell function in women with type 1 diabetes mellitus

Bjarnegård

Arnqvist

Lindström

et al. 2009

Diabetes and Vascular Disease Research

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“…Parasympathetic autonomic nervous dysfunction is characterized by an increase in heart rate, which can already be found in otherwise uncomplicated DM-1 patients. 5,29 Increases in heart rate per se result in stiffening of arteries independently of changes in activity of the autonomic nervous system. 26,27 The relationship between the DRRmax value and the carotid and femoral compliance coefficients appeared partly to be mediated by the heart rate.…”

Section: Discussionmentioning

confidence: 99%

“…15 Execution of these tests and analysis of heart rate variability (HRV) have been described previously. 5 In brief, the deep in-and expiration test (IE test) determines the maximal difference in duration of the RR interval of the ECG during deep inspiration and expiration, and is considered to be an estimate of parasympathetic nervous function. The LS test quantifies first the initial increase in heart rate after standing up by determining the shortening of the RR interval (DRRmax (ms)) of the ECG after this manoeuvre; second, it determines the ratio of the duration of the longest RR interval around the 30th and the shortest RR interval around the 15th heart beat after standing up (RRmax/RRmin ratio or max/min ratio).…”

Section: Autonomic Nervous Functionmentioning

confidence: 99%

“…These abnormalities include small elevations of blood pressures, a decreased blood pressure decline during sleep, increases in arterial stiffness and impaired autonomic nervous function. [5][6][7][8] Although these abnormalities might be separate and unrelated consequences of the hyperglycaemic environment, it is plausible that abnormalities of the autonomic nervous system and the cardiovascular system are interrelated.…”

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confidence: 99%

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Autonomic nervous function, arterial stiffness and blood pressure in patients with Type I diabetes mellitus and normal urinary albumin excretion

et al. 2004

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Type I diabetic patients (DM-1) with an elevated urinary albumin excretion (UAE430 mg/24 h) have a high cardiovascular risk. However, DM-1 patients with normal UAE have incipient abnormalities of the cardiovascular and nervous systems, such as elevations of blood pressures, increases in arterial stiffness and deterioration of autonomic nervous function. We studied the interrelationships of these abnormalities in normoalbuminuric DM-1 patients. In 76 patients, we performed two cardiovascular reflex tests (deep in-and expiration test (IE test) and lying-to-standing test (LS test)), and determined aortic pulse wave velocity (PWV), local arterial compliances of the common carotid, femoral and brachial arteries, and 24-h blood pressures. The DRRmax value of the LS test was associated with aortic PWV (negatively) and the compliance coefficients of the carotid, femoral and brachial arteries. Per 100-ms increase in DRRmax, pulse wave velocity decreased by 0.39 m/s, compliance coefficients of the carotid, femoral and brachial arteries increased by 0.06, 0.08 and 0.05 mm 2 /kPa, respectively. These associations were independent of age, 24-h mean arterial pressure and 24-h heart rate. Increases in arterial stiffness were associated with increases in 24-h systolic and pulse pressure (per 1 m/s increase in PWV, systolic and pulse pressure increased by 2.1 and 1.7 mmHg, respectively). In normoalbuminuric DM-1 patients, deterioration of autonomic nervous function is associated with an increase in arterial stiffness, which, in turn, was associated with, and may cause, increased systolic and pulse pressure. These findings suggest that preventive strategies targeting autonomic dysfunction may reduce cardiovascular morbidity in diabetes.

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“…he circadian pattern of blood pressure in patients with diabetic nephropathy shows a loss of nocturnal blood pressure reduction (1,2). Impaired diurnal autonomic nervous rhythm is one of the causes that blunt nocturnal decline in blood pressure (2) and increase urinary albumin excretion (3).…”

mentioning

confidence: 99%

Effects of Losartan and Amlodipine on Urinary Albumin Excretion and Ambulatory Blood Pressure in Hypertensive Type 2 Diabetic Patients With Overt Nephropathy

et al. 2005

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OBJECTIVE -Few studies have assessed whether 24-h blood pressure control induced by antihypertensive agents improves macroalbuminuria in hypertensive type 2 diabetic patients with overt nephropathy. We evaluated the effects of losartan and amlodipine on 24-h blood pressure, autonomic nervous activity, and albuminuria in these patients. RESEARCH DESIGN AND METHODS-In this open-label, parallel-prospective, randomized study, 44 patients were treated with losartan and 43 with amlodipine for a 12-week titration phase and a maintenance phase for a maximum of 12 weeks. Twenty-four-hour blood pressure and urinary albumin excretion were measured before and during treatment. Simultaneously, power spectral analysis of heart rate was performed to evaluate low frequency (LF) and high frequency (HF) components and LF-to-HF ratios as an index of sympathovagal balance.RESULTS -Losartan decreased (P Ͻ 0.001) mean blood pressure from 162/91 to 150/82 mmHg during daytime and from 146/82 to 137/74 mmHg during nighttime (systolic/diastolic). Amlodipine also decreased (P Ͻ 0.001) blood pressure from 159/90 to 147/82 mmHg during daytime and from 143/81 to 131/72 mmHg during nighttime. LF and HF components and nighttime-to-daytime ratios for the LF-to-HF ratios did not differ during treatment in two groups, showing no changes in the diurnal autonomic nervous rhythm. Losartan decreased (P Ͻ 0.001) 24-h urinary albumin excretion from 810 mg/day (95% CI 780 -1,140) to 570 (510 -910). Amlodipine, however, did not decrease (P ϭ 0. CONCLUSIONS -These results suggest that in type 2 diabetes with overt nephropathy, 24-h blood pressure regulation alone is inadequate to reduce macroalbuminuria and additional effects of losartan are crucial for antiproteinuric action. Diabetes Care 28:1862-1868, 2005T he circadian pattern of blood pressure in patients with diabetic nephropathy shows a loss of nocturnal blood pressure reduction (1,2). Impaired diurnal autonomic nervous rhythm is one of the causes that blunt nocturnal decline in blood pressure (2) and increase urinary albumin excretion (3). Thus, there is a close relation between loss of nocturnal blood pressure fall and albuminuria in diabetic nephropathy (4), although it remains controversial as to which precedes. If loss of nocturnal blood pressure decline hastens the development of albuminuria, intensified nocturnal blood pressure regulation by antihypertensive treatment can be expected to decrease the risk of albuminuria. In fact, several classes of antihypertensive agents have been reported to reduce blood pressure throughout 24 h in hypertensive patients with diabetes (5-7). However, in hypertensive patients with advanced type 2 diabetic nephropathy, it is important to clarify whether 24-h blood pressure control, especially nocturnal blood pressure reduction, induced by antihypertensive agents improves macroalbuminuria, a well-established predictor of end-stage renal disease.The aim of the present prospective study was to compare the effects of losartan, an angiotensin II receptor blocker, w...

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Ambulatory blood pressures and autonomic nervous function in normoalbuminuric type I diabetic patients.

Cited by 24 publications

References 0 publications

Long-term hyperglycaemia impairs vascular smooth muscle cell function in women with type 1 diabetes mellitus

Long-term hyperglycaemia impairs vascular smooth muscle cell function in women with type 1 diabetes mellitus

Autonomic nervous function, arterial stiffness and blood pressure in patients with Type I diabetes mellitus and normal urinary albumin excretion

Effects of Losartan and Amlodipine on Urinary Albumin Excretion and Ambulatory Blood Pressure in Hypertensive Type 2 Diabetic Patients With Overt Nephropathy

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