Effects of impaired glucose metabolism on heart rate variability and blood pessure variability in essential hpertensive patients

Abstract

To investigate the effects of impaired glucose metabolism (IGM) on cardiovascular autonomic nervous systems in essential hypertensive (EH) patients by comparing heart rate variability (HRV) and blood pressure variability (BPV) in EH patients with or without type 2 diabetes mellitus (T2DM). Simultaneous 24-h recordings of ambulatory ECG and blood pressure monitoring were performed in 36 male old patients with simple EH and 33 male old patients with EH combined with T2DM. HRV analysis included time domain parameters such as SDNN, SDANN, SDNNi, rMSSD and pNN50, and total spectral power (TP) of HRV, which mainly consists of VLF, LF and HF component along with LF/HF ratio, was also obtained. The value of ambulatory blood pressure was represented as the mean blood pressure (mean systolic/mSBP, diastolic/mDBP and pulse pressure/mPP) during different periods (24 h/24 h, day time/d and night time/n). Standard deviation (SD) as well as coefficient of variance (CV) of blood pressure during each above-mentioned period were obtained to reflect the long-term BPV. Our result showed that SDNN, SDNNi, SDANN, rMSSD, PNN50, TP and HF of HRV in cases of EH with T2DM were all significantly lower than those in simple EH subjects (P<0.05). No significant differences in VLF or LF was found between the two groups (P>0.05), while LF/HF ratio was significantly higher in EH with T2DM patients than in simple EH subjects (P<0.01). Moreover, dmSBP, 24 h-mPP and dmPP were all significantly higher in EH with T2DM patients than in simple EH subjects (P<0.05), while nmSBP, 24 h-mSBP, 24 h-mDBP, dmDBP, nmDBP or nmPP showed no significant difference between this two groups of patients (P>0.05). And dSBPSD, dSBPCV and 24 h-SBPSD were all significantly higher in EH with T2DM patients than in simple EH subjects (P<0.05), while the other BPV indexes showed no significant difference between this two groups (P>0.05). It is concluded that the cardiovascular autonomic nervous systems in EH patients was further impaired by T2DM, displaying lowering of HRV and enlargement of BPV, which in turn induced abnormal structural and functional changes of cardiovascular systems. Therefore, improving cardiovascular autonomic nervous systems might reduce the occurrence of cardiovascular complications in the EH patients with IGM.

Effects of percutaneous coronary intervention on the ambulatory blood pressure of patients with hypertension and coronary heart disease

“…Blood pressure is affected by several factors, including cardiac output, peripheral vascular resistance and blood volume. In addition, the regulation of arterial blood pressure is affected by the functional status of the target organ and the autonomic function [3,4]. Would myocardial ischemia change the blood pressure?…”

Heart rate variability in type 2 diabetes mellitus: A systematic review and meta-analysis

“…Gender. The proportion of men varied from 35% [45] to 100% [50] in T2DM patients, with a mean of 52.2%, and from 28% [54] to 100% [60] in the control group, with a mean of 54.5%. One study did not specify the proportion of men with T2DM [53], while 3 studies did not specify it for the controls [53,57,59].…”

“…Both the T2DM patients and the controls had cardiovascular diseases in five studies [42,48,51,56,60] and renal disease in three studies [43,46,52]. Five studies assessed the influence of high blood pressure on HRV in T2DM compared with healthy controls [49,50,54,55,58]. Other studies compared HRV between T2DM patients and controls based on blood catecholamine levels [44], circadian autonomic rhythm in insulinoresistant subjects [45], in cases of bowel preparation [63], metabolic syndrome [47], circadian rhythm in relation to blood adiponectin [62], or dimethylarginine levels [61], hypoglycaemic episodes [59], in acromegalic patients [53], and inhalation of ultrafine particles [57].…”

“…In each individual study, exclusion criteria were the same as for T2DM, i.e. pregnancy [43,62], neurological disease [43], BMI over 25 kg/m 2 [42,44,45] or 35 kg/m 2 [58,62], chronic heart [42,44,45,[50][51][52]57,58,[60][61][62][63], liver [56,60,63], or renal [42,42,45,56,58,[60][61][62][63] failure, thyroid disorder [50,52], or treatment that can influence HRV parameters [44][45][46]52,54,[57][58][59][60]. Controls had high blood pressure in five studies [49,56,58,60,62], and were on dialysis in three studies [43,…”

“…Healthy controls were paired with T2DM patients based on age [41,43,44,46,47,49,50,52,53,58,59,62], gender [42,44,45,47,51,59,60,63], body weight [50,59], BMI [44], and blood pressure [60].…”