Relationship between autonomic neuropathy and hypertension—are we underestimating the problem?

Istenes, Ildikó; Keresztes, Katalin; Hermányi, Zsolt; Putz, Zsuzsanna; Vargha, P.; Gandhi, Rajiv; Tesfaye, Solomon; Kempler, Péter

doi:10.1111/j.1464-5491.2008.02458.x

Cited by 34 publications

(27 citation statements)

References 10 publications

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“…Using ambulatory BP monitoring (ABPM), hypertension could be diagnosed in 54 and 29% of type 2 DM patients with/without CAN in spite of normal office BP and no history of hypertension [30]. In this context, hypertension may remain unrecognized in up to half of the patients with CAN [30].…”

Section: Discussionmentioning

confidence: 99%

“…Previously, both hypertension and DM were found to be associated with impaired autonomic function: they negatively influence most CARTs [28], baroreflex sensitivity and heart rate variability [29][30][31] with their effects being additive [32,33]. Nevertheless, the handgrip test seems to be the only measure of CAN being conversely affected by DM and hypertension.…”

Section: Discussionmentioning

confidence: 99%

“…The majority of patients with DM, especially those with autonomic neuropathy, have hypertension as well [30,32,36,46,47]. Most patients with DM and hypertension are treated with ACE inhibitors, while these drugs might have an effect on autonomic function as well.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Why Not to Use the Handgrip Test in the Assessment of Cardiovascular Autonomic Neuropathy Among Patients with Diabetes Mellitus?

Körei

Kempler

Istenes

et al. 2016

CVP

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Why Not to Use the Handgrip Test in the Assessment of Cardiovascular Autonomic Neuropathy Among Patients with Diabetes Mellitus?

Körei

Kempler

Istenes

et al. 2016

CVP

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“…Cardiac autonomic neuropathy is a severe complication of diabetes and is associated with impaired left ventricular function, impaired dilations of coronary resistance vessels, unawareness of hypoglycemia, exercise intolerance, increased intraoperative cardiovascular risk, increased arterial pulse pressure, and a higher prevalence of reduced circadian variation in blood pressure (31). Furthermore, cardiac autonomic neuropathy has been associated with an increased risk of compromised cerebral blood flow (32,33), hypertension (34), silent myocardial ischemia (35), and higher cardiovascular mortality (10).…”

Section: Discussionmentioning

confidence: 99%

Glycemic Variability Is Associated With Reduced Cardiac Autonomic Modulation in Women With Type 2 Diabetes

et al. 2015

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OBJECTIVETo investigate the sex differences in cardiac autonomic modulation in patients with newly diagnosed type 2 diabetes and to determine whether cardiac autonomic modulation is associated with glycemic variability. RESEARCH DESIGN AND METHODSWe investigated a cohort consisting of 48 men and 39 women with non-insulin-treated type 2 diabetes and a known duration of diabetes <5 years. All patients were equipped with a continuous glucose monitoring sensor for 3 days, and the mean amplitude of glycemic excursions (MAGE) was calculated to obtain individual glycemic variability. Cardiac autonomic modulation was quantified by analysis of heart rate variability (HRV) in time and frequency domains and during cardiovascular reflex tests (response to standing [RS], deep breathing [expiration-inspiration], and Valsalva maneuver). RESULTSSex differences in age-and heart rate-adjusted HRV measures were observed in both active and passive tests. Low frequency (LF; P = 0.036), LF/high frequency (HF; P < 0.001), and RS (P = 0.006) were higher in men, whereas expiration-inspiration (P < 0.001), but not HF, was higher in women. In women, reduced cardiac autonomic modulation as assessed by the standard deviation of normal-to-normal intervals (P = 0.001), the root mean square of successive differences (P = 0.018), LF (P < 0.001), HF (P = 0.005), total power (P = 0.008), RS ratio (P = 0.027), and expiration-to-inspiration ratio (P = 0.006) was significantly associated with increased glycemic variability as assessed by MAGE. This was not the case in men. The association in women persisted in a multivariate regression analysis controlling for weight, mean heart rate, blood pressure (systolic), and triglycerides. CONCLUSIONSIn patients with newly diagnosed and well-controlled type 2 diabetes, increased glycemic variability was associated with reduced cardiac autonomic modulation in women but not in men.Evidence points toward a cardioprotective effect of sex hormones (estrogen and progesterone) in premenopausal women, one possibly mediated through improved cardiac autonomic balance both centrally and peripherally by suppression of sympathetic tone and elevation of parasympathetic tone (1,2). The presence of diabetes has been shown to reduce the sex difference and minimize cardioprotection in

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“…Важное значение этому обстоя-тельству придает тот факт, что основной причиной смерти пациентов с СД2 являются заболевания сер-дечно-сосудистой системы [32]. Кроме того, у взрос-лых пациентов с СД2 и КАН риск смерти выше, чем у пациентов без КАН [33,34].…”

Section: результаты и обсуждениеunclassified

The cardiovascular form of autonomous neuropathy in the adolescents with type 2 diabetes mellitus

Еремина¹,

Лаптев²,

Zilberman³

et al. 2014

Probl Endokrinol (Mosk)

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Objective. To estimate the prevalence of the cardiovascular form of autonomous neuropathy (CAN) and the factors associated with this condition in the adolescents suffering from type 2 diabetes mellitus (DM2) in comparison to the adolescents present- ing with type 1 diabetes mellitus (DM1). Material and methods. The study included 24 adolescents with DM2 and 30 ones with DM1 matched for the age, duration of the disease, and the quality of its compensation. The control group was comprised of 17 adolescents with exogenous constitutional obesity (ECO). All the patients were examined by means of Holter ECG monitoring with the estimation of the daily cardiac rhythm variability based on the mean weighted variation of rhythmogram (MWVR) and the length of the QTc interval. In addition, standard cardiovascular tests were performed including deep-breath test, the Valsalva maneuver, and the 30:15 intermittent fitness test. Cardiovascular autonomous neuropathy was diagnosed in the patients exhibiting deviation from the normal values in 3 of the five parameters of interest, viz. MWVR, QTc length, and three functional tests. Results. CAN at the subclincal stage was more frequently diagnosed in the adolescents with DM2 than in those suffering DM1 (29.2 and 10% of the cases respectively; p<0.05). This condition was not found in any of the patients presenting with endogenous constitutional obesity. MWVR in the adolescents with DM2 was lower than in the patients with DM1 (p=0.02) or ECO (p=0.04). The QTc duration was greater in the DM2 patients than in the adolescents of the same age presenting with ECO (p=0.02) and comparable with that in the patients suffering DM1 (p=0.3). In the adolescents with DM2, positive correlation between CAN, the duration of diabetes, the quality of its compensation, and the patient’s age was documented while the length of the QTc interval negatively correlated with these three variables. Moreover, the occurrence of CAN positively correlated with peripheral neuropathy. No relationship with the severity of insulin resistance was observed.

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Relationship between autonomic neuropathy and hypertension—are we underestimating the problem?

Cited by 34 publications

References 10 publications

Why Not to Use the Handgrip Test in the Assessment of Cardiovascular Autonomic Neuropathy Among Patients with Diabetes Mellitus?

Why Not to Use the Handgrip Test in the Assessment of Cardiovascular Autonomic Neuropathy Among Patients with Diabetes Mellitus?

Glycemic Variability Is Associated With Reduced Cardiac Autonomic Modulation in Women With Type 2 Diabetes

The cardiovascular form of autonomous neuropathy in the adolescents with type 2 diabetes mellitus

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