Ambulatory blood pressure recording in diabetic patients with abnormal responses to cardiovascular autonomic function tests

Abstract

The aim of our study was to analyse the 24-h periodic pattern of blood pressure (BP) in diabetic patients with abnormal responses to cardiovascular reflexes, in order to evaluate the extent of the initial autonomic damage. We studied 44 patients with diabetes mellitus (14 insulin-dependent, 30 non-insulin-dependent; mean duration of disease 6.5 +/- 1.8 years) in good metabolic control (fasting glycaemia less than 140 mg/dl, postprandial glycaemia less than 180 mg/dl, fructosamine less than 285 mg/dl), divided into two subgroups, containing 21 normotensives (13 males and 8 females aged 28-72 years) and 23 hypertensives (13 males and 10 females aged 32-70 years) respectively. All patients showed abnormal responses to at least two out of four tests: deep breathing, lying to standing, Valsalva manoeuvre and postural hypotension. Two sex- and age-matched control groups were recruited, comprising 20 normotensive and 20 hypertensive diabetic patients without dysautonomia, respectively. The reference group consisted of 248 normotensives (135 males and 113 females, aged 18-76 years) and 212 mild-moderate hypertensives (130 males and 82 females, aged 27-66 years). Each patient underwent ambulatory BP monitoring for at least 24 h, using an auscultatory automatic device. Data concerning biological rhythms were analysed by means of periodic functions. We limited the Fourier partial sums to the first three harmonics.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood pressure and cardiac autonomic function in relation to risk factors and treatment perspectives in Type 1 diabetes

“…In addition to elevated BP 29,[42][43][44] with an attenuated circadian rhythm, 30,45 vagal function is impaired with an abnormal sympathovagal interaction, 46,47 the lipid profile is more atherogenic, 48,49 there are features of endothelial dysfunction, [50][51][52] and retinopathy is more prevalent. [81][82][83] Records with more than two missing night or day readings were excluded. 54 In addition, ultrastructural findings 55,56 indicate the presence of glomerular and arteriolar abnormalities in Type 1 diabetic patients with incipient nephropathy.…”

“…80 Other techniques for assessment of circadian BP variation implies mathematical smoothing procedures and assumes an inherent rhythm of BP. [81][82][83] Records with more than two missing night or day readings were excluded. Under standardised conditions (e.g.…”