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

Abstract

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.

Arterial stiffness is associated with depression in middle-aged men — the Maastricht Study

“…40 Systemic low-grade inflammation on the other hand, could via multiple pathways stimulate the production of proinflammatory markers by microglial cells in the brain, which could induce symptoms of depression. [41][42][43] Fourth, other factors, such as autonomic and hypothalamic-pituitary-adrenal axis dysfunction may underlie both arterial stiffness 44,45 and depression. 46,47 Finally, behavioural risk factors, such as high alcohol intake, smoking and physical inactivity, are bidirectionally associated with depression 3,[48][49][50] and may also lead to arterial stiffening, [51][52][53] thus confounding the association.…”

Arterial Stiffness and Cardiovascular Autonomic Dysfunction in Patients with Parkinson's Disease

“…Blood vessels are abundantly innervated by sympathetic nerves. An increase in arterial stiffness can lead to a decrease in distension of the artery and thereby disturb the autonomic control of BP [21]. In this study, PD itself did not affect increasing PWV, whereas autonomic BP disturbances influenced the alteration of arterial stiffness and architectural change in the arteries of patients with PD.…”

N-Terminal Pro-Brain Natriuretic Peptide, Cardiac and Vascular Function in Patients with Type 1 Diabetes Mellitus during the Ascent of Mt. Kilimanjaro

“…However, PWV did not change significantly during this relatively short stay at 4,000 m. High altitude was associated with higher blood pressure, which was more prominent in the control group. Blood pressure is an important contributor to arterial stiffness [4] and may influence PWV. Few studies have been done on vascular measurements at high altitude.…”

“…In general, patients with T1DM have an increased cardiovascular mortality and morbidity risk compared to non-diabetic subjects. Many complications in T1DM have a cardiovascular background [4,5]. Amongst others, chronic glucose dysregulation is a mediator of cardiovascular risk in these patients, contributing to impaired endothelial and diastolic function, as well as affecting microand macro vasculature.…”

“…Arterial stiffening has been described as an early phenomenon in subjects with T1DM that presents even before the onset of cardiovascular complications. Arterial stiffness itself is associated with increased systolic and pulse pressure [4]. Stiffening of the aorta affects cardiac function by increasing the afterload and reducing coronary artery perfusion during diastole [6].…”