Heart Rate and Systolic Blood Pressure Variability in the Time Domain in Patients with Recent and Long-Standing Diabetes Mellitus

Abstract

Diabetes Mellitus (DM) affects the cardiovascular response of patients. To study this effect, interbeat intervals (IBI) and beat-to-beat systolic blood pressure (SBP) variability of patients during supine, standing and controlled breathing tests were analyzed in the time domain. Simultaneous noninvasive measurements of IBI and SBP for 30 recently diagnosed and 15 long-standing DM patients were compared with the results for 30 rigorously screened healthy subjects (control). A statistically significant distinction between control and diabetic subjects was provided by the standard deviation and the higher moments of the distributions (skewness, and kurtosis) with respect to the median. To compare IBI and SBP for different populations, we define a parameter, α, that combines the variability of the heart rate and the blood pressure, as the ratio of the radius of the moments for IBI and the same radius for SBP. As diabetes evolves, α decreases, standard deviation of the IBI detrended signal diminishes (heart rate signal becomes more “rigid”), skewness with respect to the median approaches zero (signal fluctuations gain symmetry), and kurtosis increases (fluctuations concentrate around the median). Diabetes produces not only a rigid heart rate, but also increases symmetry and has leptokurtic distributions. SBP time series exhibit the most variable behavior for recently diagnosed DM with platykurtic distributions. Under controlled breathing, SBP has symmetric distributions for DM patients, while control subjects have non-zero skewness. This may be due to a progressive decrease of parasympathetic and sympathetic activity to the heart and blood vessels as diabetes evolves.

Blood pressure regulation determined by ambulatory blood pressure profiles in children and adolescents with type 1 diabetes mellitus: Impact on diabetic complications

“…Systolic BPV increases with duration of T2DM implying a progressive development of rigidity of the heart in diabetes. In newly diagnosed T2DM, systolic BPV is similar to non‐diabetic subjects; supporting our observation that in early stages of diabetes BPV does not necessarily increase.…”

“…21 Our T1DM patients have increased blood glucose and BP levels, progressive development of rigidity of the heart in diabetes. In newly diagnosed T2DM, systolic BPV is similar to non-diabetic subjects 23 ;…”

Association between blood pressure variability, cardiovascular disease and mortality in type 2 diabetes: A systematic review and meta‐analysis

“…Full‐text versions of the remaining 73 articles were retrieved and singularly examined. Ultimately, 47 studies were excluded and, of the remaining 26 papers that were included, 22 were selected for quantitative analysis . Secondary endpoints (i.e.…”

Loss of Breathing Modulation of Heart Rate Variability in Patients with Recent and Long Standing Diabetes Mellitus Type II

“…Long-term records show reduced power in all spectral bands [22–27], failure to increase LF during standing related to a depressed baroreceptor sensitivity [24, 25], a leftward shift of the central frequency of the LF band towards lower frequencies [25] without a significant difference in the LF/HF ratio for diabetic patients compared to control subjects [24]. For short-term HRV, changes in the time—domain parameters, especially in variance, skewness and kurtosis, can be used as early warnings of DM autonomic neuropathy [27]. However, there are no conclusive studies of short-term records in the frequency-domain.…”