Pulse pressure and cardiovascular autonomic neuropathy according to duration of type 1 diabetes

Abstract

Background To evaluate changes in pulse pressure (PP) and markers of cardiovascular autonomic neuropathy (CAN) according to duration of type 1 diabetes mellitus (T1DM).

Squatting test: a dynamic postural manoeuvre to study baroreflex sensitivity

“…The squatting test may be used as an alternative dynamic procedure to assess the baroreflex gain [8,38,39]. During the transition from squatting to standing, there is an abrupt drop in BP associated with a reflex tachycardia, and these initial changes are followed by a rapid return to baseline values of both parameters (secondary BP increase and HR decrease) (Fig.…”

“…However, baroreflex gain was slightly but significantly decreased in overweight/obese subjects versus lean subjects and markedly decreased in elderly versus young individuals, also in agreement with data obtained from the pharmacological test using sequential nitroprusside-phenylephrine infusions [29] (Table 1). Finally, the changes in baroreflex gain measured during such a squatting test have been used to assess cardiac autonomic neuropathy in diabetic patients [8,38]. As an example, we previously reported that the baroreflex gain progressively decreased according to the duration of the disease in a population of patients with type 1 diabetes, whereas such reduction was not significant in a control nondiabetic population matched for age [8].…”

“…Finally, the changes in baroreflex gain measured during such a squatting test have been used to assess cardiac autonomic neuropathy in diabetic patients [8,38]. As an example, we previously reported that the baroreflex gain progressively decreased according to the duration of the disease in a population of patients with type 1 diabetes, whereas such reduction was not significant in a control nondiabetic population matched for age [8].…”

“…Careful analysis of BP and HR changes during both transition states, from standing to squatting and from squatting to standing, respectively, provides interesting information as far as performance of baroreflexes and haemodynamic homoeostasis [6]. For instance, the analysis of HR and BP changes occurring during a squatting test has been used by our group in patients with diabetes mellitus to assess orthostatic hypotension [7], cardiovascular autonomic neuropathy [7,8] and pulsatile stress [8].…”

Squatting test: A posture to study and counteract cardiovascular abnormalities associated with autonomic dysfunction

“…Careful analysis of BP and HR changes during both transition states, from standing to squatting and from squatting to standing, respectively, provides interesting information as far as performance of baroreflexes and haemodynamic homeostasis are concerned (Rossberg & Penaz, 1988). For instance, the analysis of HR and BP changes occurring during a squatting test has been used by our group to assess orthostatic hypotension (Scheen et al, 1990), cardiovascular autonomic neuropathy (CAN) (Philips et al, 2009) and pulsatile stress (Philips et al, 2008); Philips et al, 2010a; Philips et al, 2010b) in patients with type 1 diabetes mellitus. Furthermore, squatting position is a long recognized therapeutic manoeuvre that can improve haemodynamics in patients with some congenital cardiac diseases (tetralogy of Fallot) (Lurie, 1953;Guntheroth et al, 1968).…”