Evaluation of Cardiovascular Autonomic Neuropathy in Patients with Hypertensive Type 2 Diabetes Mellitus

Autonomic Neuropathy in Hypertension


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DOI:

https://doi.org/10.5281/zenodo.10019788

Keywords:

Diabetes Mellitus, hypertension, autonomic dysfunction, heart rate variability, heart rate turbulence

Abstract

Background: A non-invasive test called heart rate variability (HRV) and heart rate turbulence (HRT) uses sinus node rates and the sinus node rates' deceleration after premature contractions of the heart to identify cardiovascular autonomic dysfunction. The incidence of type 2 diabetes mellitus (DM), which continues to be the most significant health issue, is rising. Combining DM and hypertension raises the risk of heart disease. Our goal was to assess the impact of HRV and HRT analyses on cardiac autonomic functioning in diabetic patients who have hypertension.

Methods: A total of 108 DM patients, 50 normotensives, and 58 hypertensives were involved in this cross-sectional study. Outpatients had 24-hour Holter monitoring, and all recordings were evaluated and cleared of artifacts afterwards. After that, HRT and HRV analyses were performed.

Results: Age, gender, and comorbidity were similar across the study groups. The HRV parameters of SDNN (103.7±2.5, 113.6±1.68, p=0.002), SDANN (95.1±2.3, 103.2±2.1, p=0.014) were significantly lower in the hypertensive DM group. The HRT values did not significantly differ between the two groups.

Conclusions: In our study, asymptomatic hypertensive DM patients showed a significant decline in HRV parameters. Patients who have both diabetes and hypertension are more likely to exhibit autonomic dysfunction as seen by HRV. As a result, these people need to be monitored more carefully for cardiovascular diseases.

References

Wong ND, Glovaci D, Wong K, et al. Global cardiovascular disease risk assessment in United States adults with diabetes. Diabetes Vasc Dis Res. 2012;9(2):146-152. doi:10.1177/1479164112436403

Sousa AC, Jardim TV, Costa TO, et al. Hypertensive diabetic patients: incidence of cardiovascular and renal outcomes in a historical cohort over 11 years. Diabetol Metab Syndr. 2017;9:98. doi:10.1186/s13098-017-0296-z

Yannoutsos A, Ahouah M, Tubiana CD, et al. Hemodynamic parameters in hypertensive diabetic patients. J Hypertens. 2016;34(6):1123-1131. doi:10.1097/HJH.0000000000000898

Tatsumi Y, Ohkubo T. Hypertension with diabetes mellitus: significance from an epidemiological perspective for Japanese. Hypertens Res. 2017;40(9):795-806. doi:10.1038/hr.2017.67

Vinik AI, Ziegler D. Diabetic cardiovascular autonomic neuropathy. Circulation. 2007;115(3):387-397. doi:10.1161/CIRCULATIONAHA.106.634949

Jermendy G. Clinical consequences of cardiovascular autonomic neuropathy in diabetic patients. Acta Diabetol. 2003;40 Suppl 2:S370-4. doi:10.1007/s00592-003-0122-y

Özkeçeci G, Ünlü BS, Dursun H, et al. Heart rate variability and heart rate turbulence in patients with polycystic ovary syndrome. Anatol J Cardiol. 2016;16(5):323-327. doi:10.5152/AnatolJCardiol.2015.6307

Sen J, McGill D. Fractal analysis of heart rate variability as a predictor of mortality: A systematic review and meta-analysis. Chaos. 2018;28(7):72101. doi:10.1063/1.5038818

Watanabe MA, Schmidt G. Heart rate turbulence: a 5-year review. Hear Rhythm. 2004;1(6):732-738. doi:10.1016/j.hrthm.2004.09.003

Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation. 1996;93(5):1043-1065. doi:https://doi.org/10.1161/01.CIR.93.5.1043

Gupta N, Goel N, Kumar R. Correlation of exhaled nitric oxide, nasal nitric oxide and atopic status: A cross-sectional study in bronchial asthma and allergic rhinitis. Lung India Off Organ Indian Chest Soc. 2014;31(4):342.

Classification and Diagnosis of Diabetes. Diabetes Care. 2015;38(Supplement 1):S8 LP-S16. doi:10.2337/dc15-S005

Esh H, Agabiti E, France MA, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of. 2018.

Knuuti J, Wijns W, Saraste A, et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes: the Task Force for the diagnosis and management of chronic coronary syndromes of the European Society of Cardiology (ESC). Eur Heart J. 2020;41(3):407-477.

Satyanarayana, R Vaidya; Narothama RA. Definition and classification of CKD. In: Kidney International Supplements. Vol 3. ; 2013:19-62. doi:10.1038/kisup.2012.64

Martinez PF, Okoshi MP. Heart Rate Variability in Coexisting Diabetes and Hypertension. Arq Bras Cardiol. 2018;111(1):73-74. doi:10.5935/abc.20180118

Nagy K, Sipos E, El Hadj Othmane T. [Heart rate variability is significantly reduced in non-diabetic patients with hypertension]. Orv Hetil. 2014;155(22):865-870. doi:10.1556/OH.2014.29886

Istenes I, Körei AE, Putz Z, et al. Heart rate variability is severely impaired among type 2 diabetic patients with hypertension. Diabetes Metab Res Rev. 2014;30(4):305-312. doi:10.1002/dmrr.2496

Bassi D, Cabiddu R, Mendes RG, et al. Effects of coexistence hypertension and type II diabetes on heart rate variability and cardiorespiratory fitness. Arq Bras Cardiol. 2018;111(1):64-72.

Cygankiewicz I. Heart rate turbulence. Prog Cardiovasc Dis. 2013;56(2):160-171. doi:10.1016/j.pcad.2013.08.002

Balcıoğlu S, Arslan U, Türkoğlu S, Özdemir M, Çengel A. Heart Rate Variability and Heart Rate Turbulence in Patients With Type 2 Diabetes Mellitus With Versus Without Cardiac Autonomic Neuropathy. Am J Cardiol. 2007;100(5):890-893. doi:https://doi.org/10.1016/j.amjcard.2007.03.106

Yu Y, Xu Y, Zhang M, Wang Y, Zou W, Gu Y. Value of assessing autonomic nervous function by heart rate variability and heart rate turbulence in hypertensive patients. Int J Hypertens. 2018;2018.

Miwa Y, Miyakoshi M, Hoshida K, et al. Heart rate turbulence can predict cardiac mortality following myocardial infarction in patients with diabetes mellitus. J Cardiovasc Electrophysiol. 2011;22(10):1135-1140.

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Published

2023-10-20

How to Cite

Alan Yalım, S., & Yalım, Z. (2023). Evaluation of Cardiovascular Autonomic Neuropathy in Patients with Hypertensive Type 2 Diabetes Mellitus: Autonomic Neuropathy in Hypertension. Journal of European Internal Medicine Professionals, 1(4), 129–133. https://doi.org/10.5281/zenodo.10019788

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