Plasma levels of immunoreactive atrial natriuretic hormone in patients with diabetes mellitus

Abstract

In order to determine whether atrial natriuretic hormone (ANH) secretion is altered in diabetic patients with autonomic neuropathy, plasma immunoreactive ANH (IR-ANH) levels were measured in 23 patients with insulin-dependent diabetes mellitus, 12 of whom had definite cardiac autonomic neuropathy determined by noninvasive maneuvers. Levels were also measured in 31 healthy control subjects. Whereas only one of the 11 diabetics without cardiac autonomic neuropathy had elevated IR-ANH levels, four of the 12 diabetics with cardiac autonomic neuropathy had elevated IR-ANH levels (P = 0.03 compared to control subjects). 24-h urinary sodium excetion was not different among the groups. There was no significant correlation between IR-ANH levels and diabetes control and any of the parameters of autonomic nervous system activity nor between IR-ANH levels and plasma norepinephrine or epinephrine levels. Furthermore, no relationship was observed in the diabetic subjects between IR-ANH levels and left ventricular ejection fraction determined by radionuclide ventriculography. Thus, elevated IR-ANH levels occur with greater frequency in diabetic patients with autonomic neuropathy. These elevations do not appear to be due to alterations in dietary sodium intake or left ventricular dysfunction.

Alrial Natriuretic Factor in Hypertensive and Normotensive Diabetic Patients

“…However, in these studies we evaluated plasma ANF in type I and II diabetic patients with good metabolic control, suggesting the previous findings as the consequence of volume expansion associated with hyperglycemia (8,13). In fact, raised levels of plasma ANF have been described in these conditions (7,(14)(15)(16). On the other hand, the normality of ANF levels that we found in normotensive type I and type II diabetic patients could be related to the absence of diabetes-related autonomic neuropathy and/or nephropathy.…”

Atrial Natriuretic Peptide in Diabetic Patients with Microangiopathy

“…It is also well-known that a dysautonomia involving essentially the vagal cardiac innervation develops in many patients with diabetes mellitus. Kann, Grekin and Vinik (1986) found recently that elevated plasma ANP concentrations occurred with greater frequency in diabetic patients with autonomic neuropathy since only one of the eleven intact diabetics included in their study had high ANP levels whereas the proportion was four out of twelve for the patients with cardiac dysautonomia. These results are in agreement with our previous findings in uremic patients on maintenance hemodialysis (Pruszczynski et al 1987).…”

Association of a nocturnal rise in plasma α-atrial natriuretic peptide and reversed diurnal blood pressure rhythm in hospitalized normotensive subjects with non-insulin dependent diabetes mellitus

“…Both groups, however, exhibited normal circa¬ dian PRA and plasma aldosterone rhythms with peak values in the early morning. A reciprocal change in the levels of plasma ANP and PRA or plasma aldosterone has been reported in diabetic subjects with poor glycémie control (10) and microvascular complications (11)(12)(13)(14), whereas normal circadian PRA and plasma aldosterone rhythms with peaks in the early morning occur irrespective of glycémie control and microvascular complications (26). Our two diabetic groups had similar glycémie control with high fasting plasma glucose and HbAlc.…”

“…Sodium retention and extracellular volume expansion are even more pronounced in diabetic patients with postural hypotension and/or nephropathy (5,29,31). Since cardiac autonomie dysfunction does not directly affect ANP release (13,(32)(33)(34), such water and sodium retention during daytime and its central shift with night recumbency in diabetic patients with autonomie dysfunction, especially those with postural hypotension, may contribute to elevations in BP (1) and plasma ANP (35), falls in PRA and plasma aldosterone (28,29), altered diurnal changes in BP and plasma ANP with their nocturnal rises, and nocturnal diuresis and natriuresis (6).…”

“…Since diabetic and non-diabetic subjects with autonomie neuropathy have volume-dependent supine hyperten¬ sion accompanying postural and post-prandial hypo¬ tension (4,5), probably resulting in nocturnal natriuresis and diuresis (6), presumed daytime sodium and fluid retention could also contribute to the nocturnal rise of supine blood pressure (1)(2)(3)7). Tn recent years, atrial natriuretic peptide (ANP), a potent natriuretic, diuretic and vasorelaxant hormone (8), has been recognized as playing an important role in the regulation of electrolyte balance and blood pressure (9), and alterations in plasma ANP have been reported in diabetes mellitus (10)(11)(12)(13)(14). In the present study, we examined the relationships between diurnal changes in blood pressure and ANP in non-insulin-dependent diabetes mellitus (NIDDM) subjects, with special attention focused on the presence of autonomie neuropathy.…”