Comparative study of cardiac autonomic status by heart rate variability between under-treatment normotensive and hypertensive known type 2 diabetics

Solanki, Jayesh Dalpatbhai; Basida, Sanket; Mehta, Hemant B; Panjwani, Sunil J.; Gadhavi, Bhakti P

doi:10.1016/j.ihj.2016.07.013

Cited by 18 publications

(18 citation statements)

References 35 publications

(40 reference statements)

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“…LF/HF ratio denotes sympatho-vagal balance, and an increase signifies sympathetic dominance which could result from either damage to cardiac autonomic nerves by hyperglycemia in T2DM or by the sympathetic overactivity as seen in HTN. Findings of Solanki et al 44 , 45 were in contrast to those of previous studies, where they reported no significant effect of HTN on autonomic function in T2DM. However, they did not include healthy controls or a euglycemic hypertensive group which makes it difficult to compare it with the results of the present study.…”

Section: Discussioncontrasting

confidence: 89%

“…More recently, Istenes et al 14 assessed resting HRV using the frequency domain measures and found an additive effect of HTN on impaired autonomic function in diabetic patients. However, Solanki et al 44 , 45 found non-significant difference in HRV parameters (frequency domain, time domain and non-linear measures) between diabetics with optimal vs. poor BP control. They recorded no difference in the overall HRV except for LF/HF ratio, which was found to be lower in the hypertensive diabetics.…”

Section: Discussionmentioning

confidence: 98%

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Co-Existence of hypertension worsens post-exercise cardiac autonomic recovery in type 2 diabetes

Verma

Bhati

Ahmad

et al. 2018

Indian Heart Journal

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BackgroundCardiac autonomic neuropathy (CAN) is a commonly overlooked complication of Type 2 Diabetes Mellitus (T2DM) characterized by imbalance between sympathetic and parasympathetic supply to the heart. The susceptibility of heart to dysrhythmias and fatal events increases during and after exercise due to a shift in autonomic regulation. Diabetes and hypertension (HTN) frequently occur concurrently and both conditions lead to impaired cardiac autonomic control. However, their impact together on post-exercise autonomic recovery remains to be explored.ObjectiveThe objective of the study was to investigate the effect of co-existence of HTN on cardiac autonomic recovery (assessed by heart rate recovery and heart rate variability) in patients with T2DM.MethodsForty eight type 2 diabetic patients (24 normotensive, 24 hypertensive), 24 non-diabetic patients with essential HTN, and 27 healthy controls, were recruited into the study and assessed for heart rate recovery (HRR) following a graded maximal test. Also, heart rate variability (HRV) was recorded before and following the bout of maximal exercise.ResultsHeart rate recovery at 1 (HRR1min) and 2 (HRR2min) minute(s) showed significant effects for DM (p < 0.001) and HTN (p < 0.001), while DM × HTN interaction was found to be non-significant. Resting HRV showed a significant decline in time-domain variables for the DM group (p < 0.01). Recovery of HRV showed a significant effect of time (p < 0.05) for all indices, the group effect was found significant only for time-domain measures (p < 0.05).ConclusionBoth HRR and HRV recovery were impaired in DM and HTN. Moreover, the co-existence of HTN had a synergistic effect, causing further worsening of autonomic recovery in T2DM.

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Section: Discussioncontrasting

confidence: 89%

Section: Discussionmentioning

confidence: 98%

Co-Existence of hypertension worsens post-exercise cardiac autonomic recovery in type 2 diabetes

Verma

Bhati

Ahmad

et al. 2018

Indian Heart Journal

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“…Conveniently, the measurement of HRV is non–intrusive and pain–free [ 19 ]. Although the evaluation of HRV in T2DM has been assessed in several studies, conflicting results have been reported [ 20 – 22 ]. Moreover, there is no consensus on the decreased levels of HRV parameters in T2DM.…”

Section: Introductionmentioning

confidence: 99%

Heart rate variability in type 2 diabetes mellitus: A systematic review and meta–analysis

et al. 2018

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BackgroundCardiac autonomic neuropathy in type 2 dibetes mellitus (T2DM) patients is frequent and associated with high cardiovascular mortality. Heart rate variability (HRV) is the gold standard to measure cardiac autonomic neuropathy. We aimed to conduct a systematic review and meta–analysis to evaluate the impact of T2DM on HRV parameters.MethodsThe PubMed, Cochrane Library, Embase and Science Direct databases were searched on 1st October 2017 using the keywords “diabetes” AND (“heart rate variability” OR “HRV”). Included articles had to report HRV parameters in T2DM patients and healthy controls measured during 24 hours with a Holter–electrocardiogram. Measurements of HRV retieved were: RR–intervals (or Normal to Normal intervals—NN), standard deviation of RR intervals (SDNN), percetange of adjacent NN intervals differing by more than 50 milliseconds (pNN50), square root of the mean squared difference of successive RR intervals (RMSSD), total power, Low Frequency (LF), High Frequency (HF) and LF/HF ratio, as per Task Force recommendations.ResultsWe included twenty-five case-control studies with 2,932 patients: 1,356 with T2DM and 1,576 healthy controls. T2DM patients had significantly (P<0.01) lower RR–intervals (effect size = –0.61; 95%CI –1.21 to –0.01), lower SDNN (–0.65; –0.83 to –0.47), lower RMSSD (–0.92; –1.37 to –0.47), lower pNN50 (–0.46; –0.84 to –0.09), lower total power (–1.52; –2.13 to –0.91), lower LF (–1.08; –1.46 to –0.69]), and lower HF (–0.79; –1.09 to –0.50). LF/HF did not differ between groups. Levels of blood glucose and HbA1c were associated with several HRV parameters, as well as Time from diagnosis of T2DMConclusionsT2DM was associated with an overall decrease in the HRV of T2DM patients. Both sympathetic and parasympathetic activity were decreased, which can be explained by the deleterious effects of altered glucose metabolism on HRV, leading to cardiac autonomic neuropathy.

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“…We did not find significant difference between new or old cases and with duration less than or more than 4 years with respect to PWA parameters, in line with our previous studies in diabetics with different cardiovascular parameters. [1223242526] It indicates the importance of presence of disease, early diagnosis, physical activity, and prompt treatment more than further chronicity or glycemic control.…”

Section: Discussionmentioning

confidence: 99%

Central hemodynamics and arterial stiffness in Gujarati diabetics not receiving any antihypertensive: A case–control study based on oscillometric pulse wave analysis

Solanki

Munshi

Mehta

et al. 2019

J Family Med Prim Care

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Introduction: Diabetes is a modern epidemic imposing significant cardiovascular risk. Immediate and discrete parameters such as arterial stiffness and central hemodynamics are studied scarcely. Pulse wave analysis (PWA) offers noninvasive measurement of the same and we performed that in diabetics. Materials and Methods: We performed a case–control study on 148 treated diabetic not on antihypertensive and 148 nondiabetic normotensive controls. Oscillometric PWA was performed by Mobil-O-Graph (IEM). Parameters were further analyzed for effect of gender, physical activity, body mass index (BMI; cut-off 23), glycemic control, and disease duration (cut-off 4 years). Multiple linear regressions were used to find significant predictors. P <0.05 was taken as statistical significance. Results: Cases had significantly raised brachial hemodynamics (blood pressure, heart rate, rate pressure product), arterial stiffness (augmentation pressure, augmentation index, pulse wave velocity, total arterial stiffness, pulse pressure amplification), and central hemodynamics (central blood pressure, cardiac output, stroke work) than controls. In the case group, female gender, BMI ≥ 23, and physical inactivity were the significant factors affecting results (arterial stiffness more than central hemodynamics); glycemic control and duration were not. Heart rate was the major predictor of study parameters. Brachial pressure parameters were not significant predictors of corresponding central pressure parameters. Conclusion: Gujarati diabetics not using any antihypertensive had adverse profile of beyond brachial blood pressure discrete cardiovascular parameters, independent of duration and glycemic control, related to gender, BMI, and physical activity, indicating vascular progeria in the absence of hypertension. This baseline study suggests further work on these potential parameters.

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Comparative study of cardiac autonomic status by heart rate variability between under-treatment normotensive and hypertensive known type 2 diabetics

Cited by 18 publications

References 35 publications

Co-Existence of hypertension worsens post-exercise cardiac autonomic recovery in type 2 diabetes

Co-Existence of hypertension worsens post-exercise cardiac autonomic recovery in type 2 diabetes

Heart rate variability in type 2 diabetes mellitus: A systematic review and meta–analysis

Central hemodynamics and arterial stiffness in Gujarati diabetics not receiving any antihypertensive: A case–control study based on oscillometric pulse wave analysis

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