Diabetic Cardiac Autonomic Neuropathy: Link between Heart Rate Variability, Violated Blood Pressure Pattern, and Pulse Wave Velocity

Abstract

Abnormalities in heart rate (HR) variability (HRV) and blood pressure (BP) variability may increase the risk of cardiovascular diseases. A well-known risk factor for cardiovascular morbidity, such as arrhythmias, stroke, congestive heart failure, heart attacks, and sudden death syndrome, is cardiac autonomic neuropathy (CAN). It has been claimed that chronobiologically evaluating HRV and BP and optimizing timed treatment efficacy can significantly lower the risk of cardiac or stroke death. Physiological cardiovascular activities are under the control of the cardiac autonomic nervous system. Damage of the autonomic nerves leads to dysfunction in HR control and vascular dynamics, notably to CAN. For people with diabetes mellitus (DM), metabolic abnormalities and significant morbidity and mortality are caused by an autonomic imbalance between the sympathetic and parasympathetic nervous systems, which regulate cardiovascular function. There is a strong correlation between changes in neuroendocrine sleep architecture, circadian clock oscillations, glucose metabolism, autonomic function, and diurnal profiles of BP and HR, and there has been evidence of circadian rhythm misalignment in DM patients. The purpose of the chapter is to analyze the current state of the problem in the relationship between DM and circadian rhythm disorders, HRV, and arterial stiffness.