Association between cardiac autonomic neuropathy and hypertension and its potential influence on diabetic complications

Ayad, F.; Belhadj, M.; Pariès, J.; Attali, Jean-Raymond; Valensi, P.

doi:10.1111/j.1464-5491.2010.03027.x

Cited by 61 publications

(50 citation statements)

References 32 publications

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“…In contrast to previous studies [36], only a trend was observed in the present study between higher microalbuminuria levels and the presence of CAN, as detected by low RR E/I ratios. This may have been due to the relatively small number of subjects with microalbuminuria, which could be explained by the fact that T1DM patients with hypertension were excluded from our present study, whereas recent observational data have favoured the role of CAN in hypertension of T1DM patients [39]. Furthermore, the association of the CAN/hypertension profile with vascular complications is consistent with deleterious effects on vascular haemodynamics and structure in addition to the effects of hypertension itself.…”

Section: Discussionsupporting

confidence: 49%

Haemodynamic changes during a squat test, pulsatile stress and indices of cardiovascular autonomic neuropathy in patients with long-duration type 1 diabetes

Philips

Marchand

Scheen

2012

Diabetes & Metabolism

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Aim. -Cardiovascular autonomic neuropathy (CAN) and pulsatile stress are considered to be independent cardiovascular risk factors. This study compared haemodynamic changes during an active orthostatic test in adult patients with type 1 diabetes (T1DM), using low versus high RR E/I ratios as a marker of CAN.Methods. -A total of 20 T1DM patients with low RR E/I ratios were compared with 20 T1DM patients with normal RR E/I ratios, matched for gender (1/1 ratio), age (mean: 46 years) and diabetes duration (22-26 years); 40 matched healthy subjects served as controls. All subjects were evaluated by continuous monitoring of arterial blood pressure (Finapres ® ) and heart rate using a standardized posture test (1-min standing, 1-min squatting, 1-min standing), thus allowing calculation of baroreflex gain.Results. -Compared with controls, T1DM patients showed lower RR E/I ratios, reduced baroreflex gains, higher pulsatile stress (pulse pressure × heart rate), greater squatting-induced pulse pressure rises, orthostatic hypotension and reduced reflex tachycardia. Compared with T1DM patients with preserved RR E/I ratios, T1DM patients with low RR E/I ratios showed reduced post-standing reflex tachycardia and baroreflex gain, and delayed blood pressure recovery, but no markers of increased pulsatile stress. Interestingly, decreased baroreflex gain was significantly associated with both pulsatile stress and microalbuminuria.Conclusion. -The use of RR E/I ratios to separate T1DM patients allows the detection of other CAN markers during an orthostatic posture test, but with no significant differences in pulsatile stress or microalbuminuria. In this context, squatting-derived baroreflex gain appears to be more informative. But. -La neuropathie autonome cardiaque (NAC) et le stress pulsatile sont considérés comme des facteurs de risque cardiovasculaire indépendants. Nous avons comparé les modifications hémodynamiques pendant un test actif d'orthostatisme chez des adultes diabétiques de type 1 (DT1) séparés selon la valeur de RR E/I ratio (basse versus élevée) comme marqueur de NAC. KeywordsMéthodes. -Vingt patients DT1 avec un ratio E/I abaissé ont été comparés à 20 patients DT1 avec un ratio E/I normal, appariés pour le sexe (1/1 ratio), l'âge (moyenne : 46 années) et la durée du diabète (22-26 années). Quarante sujets sains appariés ont servi de témoins. Tous les sujets ont été évalués par une mesure continue de pression artérielle (Finapres Résultats. -Comparés aux témoins, les patients DT1 ont un ratio E/I abaissé, un gain baroréflexe diminué, un stress pulsatile (pression puisée × fréquence cardiaque) accru, une augmentation plus marquée de pression puisée en position accroupie, une hypotension orthostatique et une tachycardie réflexe réduite. Comparés aux patients DT1 avec un ratio E/I préservé, les patients DT1 avec un ratio E/I abaissé ont une diminution de la tachycardie réflexe lors du redressement et une réduction du gain baroréflexe, un retard dans la correction de l'hypotension orthostatique, mais pas d'augm...

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Section: Discussionsupporting

confidence: 49%

Haemodynamic changes during a squat test, pulsatile stress and indices of cardiovascular autonomic neuropathy in patients with long-duration type 1 diabetes

Philips

Marchand

Scheen

2012

Diabetes & Metabolism

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“…Alterations of several intertwined functional elements, such as inflammation (28), impaired endothelial function (29), dysfunctional leptin (30), and ghrelin regulation (31), might be involved, leading to an increase in sympathetic activity, a reduction of cardiac baroreflex sensitivity, and facilitating an increase in arterial pressure (32). Hypertension has been found to be a predictor of CAN in type 2 diabetes in cross-sectional studies (33)(34)(35)(36), whereas the use of antihypertensive drugs was associated with autonomic indexes in the Hoorn Study (34). Consistent with this evidence, our patients with CAN were more frequently treated for hypertension.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Cardiovascular Autonomic Neuropathy in a Cohort of Patients With Newly Diagnosed Type 2 Diabetes: The Verona Newly Diagnosed Type 2 Diabetes Study (VNDS)

et al. 2015

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OBJECTIVECardiovascular autonomic diabetic neuropathy (CAN) is a serious complication of diabetes. No reliable data on the prevalence of CAN among patients with newly diagnosed type 2 diabetes are available. Therefore, the aim of this study was to estimate the prevalence of CAN among patients with newly diagnosed type 2 diabetes. RESEARCH DESIGN AND METHODSA cohort of 557 patients with newly diagnosed type 2 diabetes with cardiovascular autonomic test results available was selected. Early and confirmed neuropathy were assessed using a standardized methodology and their prevalences determined. A multivariate logistic regression analysis was modeled to study the factors associated with CAN. RESULTSIn the entire cohort, the prevalence of confirmed CAN was 1.8%, whereas that of early CAN was 15.3%. Prevalence did not differ between men and women. In the multivariate analyses BMI results were independently and significantly associated with CAN after adjusting for age, sex, hemoglobin A 1c , pulse pressure, triglyceride-to-HDL cholesterol ratio, kidney function parameters, and antihypertensive treatment.

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“…The term 'microvascular complications' usually refers to nephropathy, retinopathy, or leg ulceration, although many complications of diabetes involve contributions from both microvascular and macrovascular disease. For example, autonomic neuropathy may contribute to hypertension, 7 which is itself a powerful risk factor for heart disease, stroke and peripheral arterial disease. 8,9 Conversely, the presence of the metabolic syndrome increased the risk of microvascular complications among 415 diabetic patients managed within primary care.…”

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confidence: 99%

Non-invited Review: Prevention of microvascular diabetic complications by fenofibrate: lessons from FIELD and ACCORD

Hermans

2011

Diabetes and Vascular Disease Research

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Microvascular complications are common in type 2 diabetes in primary care. Intensified management of glycaemia or blood pressure had little effect on microvascular complication rates in recent large trials (ADVANCE, VADT, ACCORD). In 2005, the FIELD study demonstrated a significant reduction in the need for laser treatment for retinopathy, and of progression of renal dysfunction, with fenofibrate versus placebo. The FIELD ophthalmology sub-study showed that fenofibrate reduced the risk of new retinopathy and progression of retinopathy. Also, fenofibrate versus placebo significantly reduced the risk of non-traumatic, diabetes-related amputations in a post-hoc analysis from FIELD. Recently, the results of the ACCORD Lipid study were consistent with these findings, as fenofibrate significantly reduced progression of retinopathy and albuminuria, apparently independent of effects on lipids. These findings suggest a role for fenofibrate in the prevention of major diabetic microvascular complications.

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Association between cardiac autonomic neuropathy and hypertension and its potential influence on diabetic complications

Cited by 61 publications

References 32 publications

Haemodynamic changes during a squat test, pulsatile stress and indices of cardiovascular autonomic neuropathy in patients with long-duration type 1 diabetes

Haemodynamic changes during a squat test, pulsatile stress and indices of cardiovascular autonomic neuropathy in patients with long-duration type 1 diabetes

Prevalence of Cardiovascular Autonomic Neuropathy in a Cohort of Patients With Newly Diagnosed Type 2 Diabetes: The Verona Newly Diagnosed Type 2 Diabetes Study (VNDS)

Non-invited Review: Prevention of microvascular diabetic complications by fenofibrate: lessons from FIELD and ACCORD

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