Autonomic regulation of cardiovascular system in patients with type 1 diabetes mellitus with arterial hypertension and normal blood pressure

Objective. To determine whether cardiac autonomic neuropathy (CAN) influences the development of arterial hypertension (HTN) in patients with type 1 diabetes mellitus (T1DM).

Design and methods. We examined 60 patients with T1DM (37 women and 23 men, mean age 40,3 ± 1,3 years) and 40 healthy controls (21 women and 19 men, mean age 30,0 ± 0,6 years). Clinical symptoms of CAN as well as instrumental parameters were assessed. The following methods were used: spectral analysis of heart rate variability, blood pressure changes during tilt-test, the Valsalva maneuver, test with deep respiration, hand-grip and cold-pressor test, an index 30/15, arterial and cardiopulmonary baroreflexes. Blood pressure monitor (Finometer) and occlusion plethysmograph (Dohn) with parallel registration of electrocardiogram were used for data assessment.

Results. Clinical symptoms of CAN had 39 patients with T1DM (65%), in 30 of them CAN was confirmed by instrumental methods. In 9 patients without clinical manifestations CAN was diagnosed instrumentally. The most frequent disorders in T1DM patients were the reduction of spontaneous arterial baroreflex (69%), cardiopulmonary baroreflex (64%), and heart rate variability (49%). HTN was diagnosed in 37 T1DM patients (62%) and was more frequent in patients with autonomic dysfunction (р < 0,05).The patients with CAN had longer duration of HTN (5,7 ± 2,80 vs 2,3 ± 2,80 years, р < 0,05) and higher HTN degree (χ2 = 8,06, р < 0,01) than patients without CAN.

Conclusions. Cardiac autonomic neuropathy contributes to the development of HTN in T1DM patients. Implementation of instrumental methods for timely diagnosis of CAN is reasonable in T1DM patients.

1. Красильникова Е. И., Шляхто Е. В., Каронова Т. Л., Быстрова А.А., Хмельницкий О.К., Шапкова Е.А. и др. Диабетическая нейропатия. Ученые записки Санкт-Петербургского государственного медицинского университета им. акад. И.П. Павлова 2005;XII (4):60–68. [Krasil'nikova EI, Shlyakhto EV, Karonova TL, Bystrova AA, Chmelnitsky OK, Shapkova EA et al. Diabetic neuropathy. Scientific notes of Pavlov Saint-Petersburg State Medical University 2005;XII(4):60–68. In Russian].

2. de Ferranti SD, de Boer IH, Fonseca V, Fox CS, Golden SH, Lavie CJ et al. Type 1 diabetes mellitus and cardiovascular disease. A scientific statement from the American Heart Association and American Diabetes Association. Circulation. 2014;130(13): 1110–1130.

3. Красильникова Е. И., Каронова Т.Л., Бабенко А.Ю., Гринёва Е. Н., Бреговский В. Б., Мамонтов О.В. и др. Диабетическая автономная нейропатия. Патогенез. Диагностика. Лечение. Учебное пособие. Санкт-Петербург: Издательство СпбГМУ; 2010. 45 с.[Krasil'nikova EI, Karonova TL, BabenkoAY, Grineva EN, Bregovsky VB, Mamontov OV et al. Diabetic autonomic neuropathy. Pathogenesis. Diagnostics. Treatment. Textbook. Saint-Petersburg: Publishing office of Pavlov SaintPetersburg State Medical University; 2010. 45 p.].

4. Vinik AI, Erbas T. Diabetic autonomic neuropathy. Handb Clin Neurol. 2013;117:279–294.

5. Valensi P, Pariès J, Attali JR. French Group for Research and Study of Diabetic Neuropathy. Cardiac autonomic neuropathy in diabetic patients: influence of diabetes duration, obesity, and microangiopathic complications — the French multicenter study. Metabolism. 2003;52(7):815–820.

6. Gulichsen E, Fleischer J, Ejskjaer N, Eldrup E, Tarnow L. Screening for diabetic cardiac autonomic neuropathy using a new handheld device. J Diabetes Sci Technol. 2012;6 (4):965–972.

7. Pop-Busui R. Cardiac autonomic neuropathy in diabetes. A clinical perspective. Diabetes Care. 2010;33(2):434–441.

8. Гурьева И.В., Светлова О.В. Основные принципы диагностики и лечения диабетической автономной нейропатии. Доктор Ру. 2013;1(79):94–100. [Gur'yeva IV, Svetlova OV. Main principles of diagnostics and treatment of diabetic autonomic neuropathy. Doctor Ru. 2013;1(79):94–100. In Russian].

9. Rolim LC, de Souza JST, Dib SA. Tests for early diagnosis of cardiovascular autonomic neuropathy: critical analysis and relevance. Front Endocrinol. 2013;4:173. doi:10.3389/fendo.2013.00173.

10. Vinik AI, Erbas T, Casellini CM. Diabetic cardiac autonomic neuropathy, inflammation and cardiovascular disease. J Diab Invest. 2013;4(1):4–18.

11. Mancia G, de Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G et al. 2007 Guidelines for the management of arterial hypertension: The task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2007;28 (12):1462–1536.

12. Malik М. Heart rate variability. standards of measurement, physiological interpretation, and clinical use. Task force of the European Society of Cardiology the North American Society of Pacing Electrophysiology. Circulation. 1996;93(5):1043–1065.

13. Panamonta N, Prathipanawatr T, Panamonta O. Factorsinfluencing chronic diabetic complicationsin type 1 diabetes. Southeast Asian J Trop Med Public Health. 2012;43(5):1245–1251.

14. Istenes I, Keresztes K, Hermányi Z, Putz Z, Vargha P, Gandhi R et al. Relationship between autonomic neuropathy and hypertension — are we underestimating the problem? Diabet Med. 2008;25(7):863–866.

15. Ayad F, Belhadj M, Pariés J, Attali JR, Valensi P. Association between cardiac autonomic neuropathy and hypertension and its potential influence on diabetic complications. Diabet Med. 2010;27 (7):804–811.