Baroreflexes in patients with diabetes mellitus

Ferrer, María Teresa Martínez; Kennedy, William R.; Sahinen, F. M.

doi:10.1212/wnl.41.9.1462

Cited by 39 publications

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“…An abnormal CRR is often associated with an abnormal blood pressure response to respiratory manoevers and to changes in posture (Ferrer et al 1990;Kennedy et al 1991). The frequency of myocardial infarction and the mortality rate (Niakan et al 1986;Abbot et al 1988) are known to be high among diabetic patients.…”

Section: Influence Of Pancreas Transplantation On Survival Discussionmentioning

confidence: 99%

Autonomic neuropathy and survival in diabetes mellitus: effects of pancreas transplantation

1991

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Summary. Cardiorespiratory reflexes were studied during slow breathing and a Valsalva maneuver in 232 Type 1 (insulin-dependent) diabetic subjects. At 1 to 7 years follow-up, death occurred in 23.4% of 175 patients with abnormal reflexes and in 3.5% of 57 patients with normal reflexes. The mortality rates of diabetic subjects with abnormal reflexes were 17% at 2.5 years, 33% at 5 years and 40% at 7 years, significantly higher than for patients with normal reflexes (4.6%, 4.6% and 13.8%). Among patients with abnormal reflexes, patients with a functioning pancreas transplantation had better survival rates than patients with a failed transplantation, and in long-term follow-up better than patients without transplantation. A functioning transplantation prevented the progressive decline of cardiorespiratory reflex function that occurred over time in control patients.

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Section: Influence Of Pancreas Transplantation On Survival Discussionmentioning

confidence: 99%

Autonomic neuropathy and survival in diabetes mellitus: effects of pancreas transplantation

1991

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“…The high morbidity and mortality of DM is derived from chronic micro and macrovascular complications, 1 as well as alterations in the autonomic neural control of the cardiovascular system. 2,3 Autonomic neuropathy is a common complication of DM that has been found not only in clinical but also in animal models of DM. 2,4 Studies performed in our laboratory on streptozotocin (STZ)-induced diabetic rats showed that they present long-lasting changes in blood pressure, heart rate and autonomic cardiovascular reflexes.…”

Section: Introductionmentioning

confidence: 99%

Autonomic Modulation of Arterial Pressure and Heart Rate Variability in Hypertensive Diabetic Rats

Farah

Angelis

Joaquim

et al. 2007

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modulation of arterial pressure and heart rate variability in hypertensive diabetic rats. Clinics. 2007;62(4):477-82. OBJECTIVE:The aim of the present study was to evaluate the autonomic modulation of the cardiovascular system in streptozotocin (STZ)-induced diabetic spontaneously hypertensive rats (SHR), evaluating baroreflex sensitivity and arterial pressure and heart rate variability. METHODS: Male SHR were divided in control (SHR) and diabetic (SHR+DM, 5 days after STZ) groups. Arterial pressure (AP) and baroreflex sensitivity (evaluated by tachycardic and bradycardic responses to changes in AP) were monitored. Autoregressive spectral estimation was performed for systolic AP (SAP) and pulse interval (PI) with oscillatory components quantified as low (LF:0.2-0.6Hz) and high (HF:0.6-3.0Hz) frequency ranges. RESULTS: Mean AP and heart rate in SHR+DM (131±3 mmHg and 276±6 bpm) were lower than in SHR (160±7 mmHg and 330±8 bpm). Baroreflex bradycardia was lower in SHR+DM as compared to SHR (0.55±0.1 vs. 0.97±0.1 bpm/mmHg). Overall SAP variability in the time domain (standard deviation of beat-by-beat time series of SAP) was lower in SHR+DM (3.1±0.2 mmHg) than in SHR (5.7±0.6 mmHg). The standard deviation of the PI was similar between groups. Diabetes reduced the LF of SAP (3.3±0.8 vs. 28.7±7.6 mmHg2 in SHR), while HF of SAP were unchanged. The power of oscillatory components of PI did not differ between groups. CONCLUSIONS: These results show that the association of hypertension and diabetes causes an impairment of the peripheral cardiovascular sympathetic modulation that could be, at least in part, responsible for the reduction in AP levels. Moreover, this study demonstrates that diabetes might actually impair the reduced buffer function of the baroreceptors while reducing blood pressure.

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“…The Finapres has been used in baroreflex studies and has been extensively validated against intra-arterial measurements [8]. While studies of BRS in diabetic subjects have used the Finapres [3] no comparisons with intraarterial measurements have been made. Theoretically, as IDDM can affect vascular reactivity we could simply be detecting an abnormality of the digital arteries rather than a systemic abnormality of cardiovascular control.…”

Section: Discussionmentioning

confidence: 99%

“…With improved technology, baroreceptor-cardiac reflex sensitivity (BRS) is increasingly used to assess autonomic function in diabetic patients [2,3]. Traditionally, BRS is assessed by measuring the changes in R-R interval produced in reflex to acute pharmacologically induced changes in blood pressure [4,5].…”

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Assessment of baroreceptor-cardiac reflex sensitivity using time domain analysis in patients with IDDM and the relation to left ventricular mass index

et al. 1996

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Summary Autonomic dysfunction in insulin-dependent diabetic (IDDM) patients has been associated with abnormalities of left ventricular function and an increased risk of sudden death. A group of 30 patients with IDDM and 30 age, sex and blood pressure matched control subjects underwent traditional tests of autonomic function. In addition, baroreceptor-cardiac reflex sensitivity (BRS) was assessed using time domain (sequence) analysis of systolic blood pressure and pulse interval data recorded non-invasively using the Finapres beat-to-beat blood pressure recording system. 'Up BRS' sequences-increases in systolic blood pressure associated with lengthening of R-R interval, and 'down BRS' sequences-decreases in systolic blood pressure associated with shortening of R-R interval were identified and BRS calculated from the regression of systolic blood pressure on R-R interval for all sequences. We also assessed heart rate variability using power spectral analysis and, after expressing components of the spectrum in normalised units, assessed sympathovagal balance from the ratio of low to high frequency powers. IDDM subjects underwent 2-D echocardiography to assess left ventricular mass index. Standard tests of autonomic function revealed no differences between IDDM patients and control subjects, but dramatic reductions in baroreceptor-cardiac reflex sensitivity were detected in IDDM patients. 'Up BRS' when supine was 11.2 ± 1.5 ms/mmHg (mean ± SEM) compared with 20.4 ± 1.95 in control subjects (p < 0.003) and when standing was 4.1 ± 1.9 vs 7.6 ± 2.7 ms/mmHg (p < 0.001). Down BRS when supine was 11.5 ± 1.2 vs 22 ± 2.6 (p < 0.001) and standing was 4.4 ± 1.9 vs 7.3 ± 2.5 ms/ mmHg (p < 0.003). There were significant relations between impairment of the baroreflex and duration of diabetes (p < 0.001) and poor glycaemic control (p < 0.001). From a fast Fourier transformation of supine heart rate data and using a band width of 0.05-0.15 Hz as low-frequency and 0.2-0.35 Hz as high frequency total spectral power of R-R interval variability was significantly reduced in the IDDM group for both low-frequency (473 ± 62.8 vs 746.6 ± 77.6 ms 2 p = 0.002) and high frequency bands 125.2 ± 12.9 vs 459.3 ± 89.8 ms 2 p < 0.0001. When the absolute powers were expressed in normalised units the ratio of low frequency to high frequency power (a measure of sympathovagal balance) was significantly increased in the IDDM group (2.9 ± 0.53 vs 4.6 ± 0.55, p < 0.002 supine: 3.8 ± 0.49 vs 6.6 ± 0.55, p < 0.001 standing). Thus, time domain analysis of baroreceptor-cardiac reflex sensitivity detects autonomic dysfunction more frequently in IDDM patients than conventional tests. Impaired BRS is associated with an increased left ventricular mass index and this abnormality may have a role in the increased incidence of sudden death seen in young IDDM patients. [Diabetologia (1996[Diabetologia ( ) 39: 1385[Diabetologia ( -1391

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Baroreflexes in patients with diabetes mellitus

Cited by 39 publications

References 0 publications

Autonomic neuropathy and survival in diabetes mellitus: effects of pancreas transplantation

Autonomic neuropathy and survival in diabetes mellitus: effects of pancreas transplantation

Autonomic Modulation of Arterial Pressure and Heart Rate Variability in Hypertensive Diabetic Rats

Assessment of baroreceptor-cardiac reflex sensitivity using time domain analysis in patients with IDDM and the relation to left ventricular mass index

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