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AlShahrani AN, Al‐Asoom LI, Alsunni AA, Elbahai NS, Yar T. Assessment of baroreceptor reflex sensitivity in young obese Saudi males at rest and in response to physiological challenges. Physiol Rep 2020; 8:e14625. [PMID: 33190394 PMCID: PMC7666776 DOI: 10.14814/phy2.14625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/03/2020] [Accepted: 10/05/2020] [Indexed: 11/24/2022] Open
Abstract
Autonomic imbalance in overweight/obese persons could lead to an increased risk of cardiovascular complications including hypertension and arrhythmias. Baroreceptor reflex sensitivity is a sensitive indicator to detect an altered sympathovagal balance in overweight/obese individuals. This study investigated the effects of overweight/obesity on baroreceptor sensitivity in young Saudi males at rest and in response to physiological challenges. SUBJECTS AND METHODS In this cross-sectional study, spontaneous baroreceptor sensitivity at rest and in response to deep breathing, isometric hand grip exercise and moderate intensity isotonic exercise were recorded in 20 normal weight and 20 overweight/obese subjects. Finger arterial blood pressure signal, recorded through Finometer, was used to calculate baroreceptor sensitivity through cross-correlation method. The baroreceptor sensitivity data were log transformed before application of parametric tests. RESULTS The spontaneous baroreceptor sensitivity was similar in both groups at baseline, but exhibited a significant increase during deep breathing only in normal weight (p < .001). Immediately after the isotonic exercise the baroreceptor sensitivity was significantly lower than baseline in both normal weight and overweight/obese and remained significantly lower in overweight/obese individuals compared to normal weight (p < .05) throughout the recovery period. There was a significant rise in baroreceptor sensitivity after isometric exercise in overweight/obese group only (p = .001). Pearson's correlation showed a significant negative correlation of baroreceptor sensitivity with body mass index during deep breathing (r = -.472, p = .004) and in post-isotonic exercise recovery period (r = -.414, p = .013). CONCLUSION A significantly reduced baroreceptor sensitivity response to deep breathing, reduced baroreceptor sensitivity recovery after isotonic exercise, and an exaggerated shoot up after isometric exercise in overweight/obese suggests an altered sympathovagal balance. Baroreceptor sensitivity measurements in response to physiological challenges, deep breathing, and isotonic exercise, may be more sensitive investigations for detection of early attenuation of cardiac autonomic function. This would enable timely intervention thereby delaying complications and improving the quality of life.
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Affiliation(s)
- Abdullah N. AlShahrani
- Department of PhysiologyCollege of MedicineImam Abdulrahman Bin Faisal UniversityDammamSaudi Arabia
| | - Lubna I. Al‐Asoom
- Department of PhysiologyCollege of MedicineImam Abdulrahman Bin Faisal UniversityDammamSaudi Arabia
| | - Ahmed A. Alsunni
- Department of PhysiologyCollege of MedicineImam Abdulrahman Bin Faisal UniversityDammamSaudi Arabia
| | - Nabil S. Elbahai
- Department of PhysiologyCollege of MedicineImam Abdulrahman Bin Faisal UniversityDammamSaudi Arabia
| | - Talay Yar
- Department of PhysiologyCollege of MedicineImam Abdulrahman Bin Faisal UniversityDammamSaudi Arabia
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Kück JL, Bönhof GJ, Strom A, Zaharia OP, Müssig K, Szendroedi J, Roden M, Ziegler D. Impairment in Baroreflex Sensitivity in Recent-Onset Type 2 Diabetes Without Progression Over 5 Years. Diabetes 2020; 69:1011-1019. [PMID: 32086289 DOI: 10.2337/db19-0990] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 02/10/2020] [Indexed: 11/13/2022]
Abstract
Impaired baroreflex sensitivity (BRS) predicts cardiovascular mortality and is prevalent in long-term diabetes. We determined spontaneous BRS in patients with recent-onset diabetes and its temporal sequence over 5 years by recording beat-to-beat blood pressure and R-R intervals over 10 min. Four time domain and four frequency domain BRS indices were computed in participants from the German Diabetes Study baseline cohort with recent-onset type 1/type 2 diabetes (n = 206/381) and age-matched glucose-tolerant control subjects (control 1/control 2: n = 65/83) and subsets of consecutive participants with type 1/type 2 diabetes who reached the 5-year follow-up (n = 84/137). Insulin sensitivity (M-value) was determined using a hyperinsulinemic-euglycemic clamp. After appropriate adjustment, three frequency domain BRS indices were reduced in type 2 diabetes compared with control 2 and were positively associated with the M-value and inversely associated with fasting glucose and HbA1c (P < 0.05), whereas BRS was preserved in type 1 diabetes. After 5 years, a decrease in one and four BRS indices was observed in patients with type 1 and type 2 diabetes, respectively (P < 0.05), which was explained by the physiologic age-dependent decline. Unlike patients with well-controlled recent-onset type 1 diabetes, those with type 2 diabetes show early baroreflex dysfunction, likely due to insulin resistance and hyperglycemia, albeit without progression over 5 years.
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Affiliation(s)
- Jana-Luise Kück
- Institute for Clinical Diabetology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
| | - Gidon J Bönhof
- Institute for Clinical Diabetology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Alexander Strom
- Institute for Clinical Diabetology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Oana-Patricia Zaharia
- Institute for Clinical Diabetology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Karsten Müssig
- Institute for Clinical Diabetology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Julia Szendroedi
- Institute for Clinical Diabetology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Michael Roden
- Institute for Clinical Diabetology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
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Ponte CMM, Fernandes VO, Liberato CBR, Montenegro APDR, Batista LA, Gurgel MHC, de Azevedo Karbage LB, Vasconcelos ITGF, d’Alva CB, Montenegro Júnior RM. Association between cardiovascular autonomic neuropathy and left ventricular hypertrophy in young patients with congenital generalized lipodystrophy. Diabetol Metab Syndr 2019; 11:53. [PMID: 31303898 PMCID: PMC6604128 DOI: 10.1186/s13098-019-0444-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 06/18/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Congenital generalized lipodystrophy (CGL) is a rare disorder characterized by the absence of subcutaneous adipose tissue, severe insulin resistance, diabetes mellitus, and cardiovascular complications, including cardiac autonomic neuropathy (CAN), left ventricular hypertrophy (LVH), and atherosclerosis. The present study aimed to access the association between CAN parameters and cardiovascular abnormalities in CGL patients. METHODS A cross-sectional study was conducted with 10 CGL patients and 20 healthy controls matched for age, sex, BMI, and pubertal stage. We evaluated clinical, laboratory, and cardiovascular parameters-left ventricular mass index (LVMI), interventricular septum thickness (IVS), systolic and diastolic function determined by two-dimensional transthoracic echocardiography; carotid intimal media thickness (cIMT); and cQT interval. Heart rate variability (HRV) was evaluated by spectral analysis components-high frequency (HF), low frequency (LF), very low frequency (VLF), LF/HF ratio, and total amplitude spectrum (TAS)-and cardiovascular reflexes tests (postural hypotension test, respiratory, orthostatic and Valsalva coefficients). RESULTS In CGL group, four patients (40%) had LVH and diastolic dysfunction. HF component (parasympathetic control) was lower in LVH patients. CGL patients presented higher values of cIMT and cQT interval than heathy subjects. Inverse association between LVMI and LF (p = 0.011), IVS and LF (p = 0.007), and cIMT and leptin (p < 0.001) were observed, even after adjustments by HOMA-IR, A1c, and blood pressure. In CGL group, there were associations between LMVI and HF component (IC95%: - 1.000; - 00.553), LVMI and TAS (IC95%: - 1.000; - 0.012), and IVS and HF component (IC95%: - 1.000; - 0.371). CONCLUSION The association between increased LV mass and parameters of HRV provides possible speculations about the involvement of CAN in the pathophysiology of the cardiac complications, including LVH, in patients with CGL.
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Affiliation(s)
- Clarisse Mourão Melo Ponte
- Brazilian Group for the Study of Inherited and Acquired Lipodystrophies, Faculdade de Medicina, Universidade Federal do Ceará, Rua Professor Costa Mendes 1608, Fortaleza, Ceará 60416-200 Brazil
| | - Virgínia Oliveira Fernandes
- Brazilian Group for the Study of Inherited and Acquired Lipodystrophies, Faculdade de Medicina, Universidade Federal do Ceará, Rua Professor Costa Mendes 1608, Fortaleza, Ceará 60416-200 Brazil
| | - Christiane Bezerra Rocha Liberato
- Brazilian Group for the Study of Inherited and Acquired Lipodystrophies, Faculdade de Medicina, Universidade Federal do Ceará, Rua Professor Costa Mendes 1608, Fortaleza, Ceará 60416-200 Brazil
| | - Ana Paula Dias Rangel Montenegro
- Brazilian Group for the Study of Inherited and Acquired Lipodystrophies, Faculdade de Medicina, Universidade Federal do Ceará, Rua Professor Costa Mendes 1608, Fortaleza, Ceará 60416-200 Brazil
| | - Lívia Aline Batista
- Brazilian Group for the Study of Inherited and Acquired Lipodystrophies, Faculdade de Medicina, Universidade Federal do Ceará, Rua Professor Costa Mendes 1608, Fortaleza, Ceará 60416-200 Brazil
| | - Maria Helane Costa Gurgel
- Brazilian Group for the Study of Inherited and Acquired Lipodystrophies, Faculdade de Medicina, Universidade Federal do Ceará, Rua Professor Costa Mendes 1608, Fortaleza, Ceará 60416-200 Brazil
| | - Lia Beatriz de Azevedo Karbage
- Brazilian Group for the Study of Inherited and Acquired Lipodystrophies, Faculdade de Medicina, Universidade Federal do Ceará, Rua Professor Costa Mendes 1608, Fortaleza, Ceará 60416-200 Brazil
| | - Izabella Tamira Galdino Farias Vasconcelos
- Brazilian Group for the Study of Inherited and Acquired Lipodystrophies, Faculdade de Medicina, Universidade Federal do Ceará, Rua Professor Costa Mendes 1608, Fortaleza, Ceará 60416-200 Brazil
| | - Catarina Brasil d’Alva
- Brazilian Group for the Study of Inherited and Acquired Lipodystrophies, Faculdade de Medicina, Universidade Federal do Ceará, Rua Professor Costa Mendes 1608, Fortaleza, Ceará 60416-200 Brazil
| | - Renan Magalhães Montenegro Júnior
- Brazilian Group for the Study of Inherited and Acquired Lipodystrophies, Faculdade de Medicina, Universidade Federal do Ceará, Rua Professor Costa Mendes 1608, Fortaleza, Ceará 60416-200 Brazil
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Chorepsima S, Eleftheriadou I, Tentolouris A, Moyssakis I, Protogerou A, Kokkinos A, Sfikakis PP, Tentolouris N. Pulse wave velocity and cardiac autonomic function in type 2 diabetes mellitus. BMC Endocr Disord 2017; 17:27. [PMID: 28526073 PMCID: PMC5438530 DOI: 10.1186/s12902-017-0178-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 05/15/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Increased carotid-femoral pulse wave velocity (PWV) has been associated with incident cardiovascular disease, independently of traditional risk factors. Cardiac autonomic dysfunction is a common complication of diabetes and has been associated with reduced aortic distensibility. However, the association of cardiac autonomic dysfunction with PWV is not known. In this study we examined the association between cardiac autonomic function and PWV in subjects with type 2 diabetes mellitus. METHODS A total of 290 patients with type 2 diabetes were examined. PWV was measured at the carotid-femoral segment with applanation tonometry. Central mean arterial blood pressure (MBP) was determined by the same apparatus. Participants were classified as having normal (n = 193) or abnormal (n = 97) PWV values using age-corrected values. Cardiac autonomic nervous system activity was determined by measurement of parameters of heart rate variability (HRV). RESULTS Subjects with abnormal PWV were older, had higher arterial blood pressure and higher heart rate than those with normal PWV. Most of the values of HRV were significantly lower in subjects with abnormal than in those with normal PWV. Multivariate analysis, after controlling for various confounding factors, demonstrated that abnormal PWV was associated independently only with peripheral MBP [odds ratio (OR) 1.049, 95% confidence intervals (CI) 1.015-1.085, P = 0.005], central MBP (OR 1.052, 95% CI 1.016-1.088, P = 0.004), log total power (OR 0.490, 95% CI 0.258-0.932, P = 0.030) and log high frequency power (OR 0.546, 95% CI 0.301-0.991, P = 0.047). CONCLUSIONS In subjects with type 2 diabetes, arterial blood pressure and impaired cardiac autonomic function is associated independently with abnormal PWV.
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Affiliation(s)
- Stamatina Chorepsima
- First Department of Propaedeutic and Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 17 Agiou Thoma St, 11527 Athens, Greece
| | - Ioanna Eleftheriadou
- First Department of Propaedeutic and Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 17 Agiou Thoma St, 11527 Athens, Greece
| | - Anastasios Tentolouris
- First Department of Propaedeutic and Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 17 Agiou Thoma St, 11527 Athens, Greece
| | | | - Athanasios Protogerou
- First Department of Propaedeutic and Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 17 Agiou Thoma St, 11527 Athens, Greece
| | - Alexandros Kokkinos
- First Department of Propaedeutic and Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 17 Agiou Thoma St, 11527 Athens, Greece
| | - Petros P. Sfikakis
- First Department of Propaedeutic and Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 17 Agiou Thoma St, 11527 Athens, Greece
| | - Nikolaos Tentolouris
- First Department of Propaedeutic and Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 17 Agiou Thoma St, 11527 Athens, Greece
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Abstract
Autonomic dysfunction is a frequent and relevant complication of diabetes mellitus, as it is associated with increased morbidity and mortality. In addition, it is today considered as predictive of the most severe diabetic complications, like nephropathy and retinopathy. The classical methods of screening are the cardiovascular reflex tests and were originally interpreted as evidence of nerve damage. A more modern approach, based on the integrated control of cardiovascular and respiratory function, reveals that these abnormalities are to a great extent functional, at least in the early stage of the disease, thus suggesting new potential interventions. Therefore, this review aims to go further investigating how the imbalance of the autonomic nervous system is altered and can be influenced in many chronic pathologies through a global view of cardio-respiratory and metabolic interactions and how the same mechanisms are applicable to diabetes.
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Affiliation(s)
- Luciano Bernardi
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, University of Helsinki, Helsinki, Finland.
- Research Program Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland.
- , Villaggio dei Pioppi 2, 27020, Torre d'Isola, Italy.
| | - Lucio Bianchi
- Department of Endocrinology-Diabetology-Nutrition, Jean Verdier Hospital, AP-HP, CRNH-IdF, Paris-Nord University, Bondy, France
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Fenley A, Silva LDC, Reis HV, Sampaio LM, Borghi-Silva A, Reis MS. Ajustes cardiorrespiratórios durante a manobra de acentuação da arritmia sinusal respiratória: influência do tempo da manobra sobre o volume minuto, fração expirada de CO2 e variabilidade da frequência cardíaca. FISIOTERAPIA E PESQUISA 2016. [DOI: 10.1590/1809-2950/14696023012016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO A frequência cardíaca sofre variações durante o ciclo respiratório, fenômeno conhecido como arritmia sinusal respiratória. A manobra para acentuação da arritmia sinusal respiratória (M-ASR) consiste em manter ventilação educada com uma frequência respiratória de seis ciclos por minuto com relação tempo inspiração/expiração (TI:TE) de 1:1. Este estudo tem como objetivo avaliar o comportamento do volume minuto, da fração expirada de CO2 (FeCO2 infere sobre PaCO2) e do controle autonômico da frequência cardíaca durante a M-ASR com duração maior do que 90s. Foram avaliados 16 homens jovens saudáveis (de 18 a 25 anos). Todos foram orientados a realizar inspirações e expirações lentas com duração de 10 segundos por ciclo, TI:TE de 1:1 e consequente frequência respiratória de seis incursões por minuto, durante quatro minutos. Durante a avaliação foi coletada a frequência cardíaca (FC) batimento a batimento por meio de um cardiofrequencímetro, o volume minuto (VM) e a FeCO2 através de um ergoespirômetro. Para análise estatística empregou-se ANOVA one-way (com post-hoc de Tukey) ou teste de Kruskal-Wallis (com post-hoc de Dunn) quando conveniente (p<0,05). Durante a M-ASR, a FeCO2, o VM e os índices do domínio do tempo da variabilidade da frequência cardíaca (VFC) não sofreram alterações significativas ao longo do tempo. A realização da M-ASR em jovens saudáveis, por mais de 90 segundos, pode ser executada com segurança, sem o risco de hipocapnia e sem a interferência das alterações de FeCO2 nos índices do domínio do tempo da análise de VFC da M-ASR.
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Affiliation(s)
- Alexandre Fenley
- Universidade Federal do Rio de Janeiro, Brazil; Universidade Federal do Rio de Janeiro, Brazil
| | - Leonardo da Costa Silva
- Universidade Federal do Rio de Janeiro, Brazil; Universidade Federal do Rio de Janeiro, Brazil
| | - Hugo Valverde Reis
- Universidade Federal do Rio de Janeiro, Brazil; Universidade Federal do Rio de Janeiro, Brazil
| | | | | | - Michel Silva Reis
- Universidade Federal do Rio de Janeiro, Brazil; Universidade Federal do Rio de Janeiro, Brazil
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Harjutsalo V, Groop PH. Epidemiology and risk factors for diabetic kidney disease. Adv Chronic Kidney Dis 2014; 21:260-6. [PMID: 24780453 DOI: 10.1053/j.ackd.2014.03.009] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 03/09/2014] [Accepted: 03/10/2014] [Indexed: 01/29/2023]
Abstract
Prevalence rates of diabetic kidney disease (DKD) are increasing in parallel with the incidence rates of diabetes mellitus. DKD has already become a significant health problem worldwide. Without radical improvements in prevention and treatment, DKD prevalence will continue to climb. The pathogenesis of DKD is complex and multifactorial, with genetic and environmental factors involved. Several nonmodifiable risk factors contribute to DKD, including genetics, sex, age, age at onset, and duration of diabetes. However, there are also several modifiable risk factors that have a strong effect on the risk of DKD. Traditional modifiable factors include glycemic control, blood pressure, lipids, and smoking. Other recently discovered modifiable risk factors include chronic low-grade inflammation, advanced glycation end products, and lack of physical activity. Efficient management of these modifiable risk factors may improve the prognosis of diabetic patients at risk of DKD.
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Bonyhay I, Risk M, Freeman R. High-pass filter characteristics of the baroreflex--a comparison of frequency domain and pharmacological methods. PLoS One 2013; 8:e79513. [PMID: 24244518 PMCID: PMC3828383 DOI: 10.1371/journal.pone.0079513] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 10/01/2013] [Indexed: 11/22/2022] Open
Abstract
Pharmacological methods to assess baroreflex sensitivity evoke supra-physiological blood pressure changes whereas computational methods use spontaneous fluctuations of blood pressure. The relationships among the different baroreflex assessment methods are still not fully understood. Although strong advocates for each technique exist, the differences between these methods need further clarification. Understanding the differences between pharmacological and spontaneous baroreflex methods could provide important insight into the baroreflex physiology. We compared the modified Oxford baroreflex gain and the transfer function modulus between spontaneous RR interval and blood pressure fluctuations in 18 healthy subjects (age: 39±10 yrs., BMI: 26±4.9). The transfer function was calculated over the low-frequency range of the RR interval and systolic blood pressure oscillations during random-frequency paced breathing. The average modified Oxford baroreflex gain was lower than the average transfer function modulus (15.7±9.2 ms/mmHg vs. 19.4±10.5 ms/mmHg, P<0.05). The difference between the two baroreflex measures within the individual subjects comprised a systematic difference (relative mean difference: 20.7%) and a random variance (typical error: 3.9 ms/mmHg). The transfer function modulus gradually increased with the frequency within the low-frequency range (LF), on average from 10.4±7.3 ms/mmHg to 21.2±9.8 ms/mmHg across subjects. Narrowing the zone of interest within the LF band produced a decrease in both the systematic difference (relative mean difference: 0.5%) and the random variance (typical error: 2.1 ms/mmHg) between the modified Oxford gain and the transfer function modulus. Our data suggest that the frequency dependent increase in low-frequency transfer function modulus between RR interval and blood pressure fluctuations contributes to both the systematic difference (bias) and the random variance (error) between the pharmacological and transfer function baroreflex measures. This finding suggests that both methodological and physiological factors underlie the observed disagreement between the pharmacological and the transfer function method. Thus both baroreflex measures contribute complementary information and can be considered valid methods for baroreflex sensitivity assessment.
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Affiliation(s)
- Istvan Bonyhay
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| | - Marcelo Risk
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
- Instituto Tecnologico de Buenos Aires (ITBA) and Consejo Nacional de Investigaciones Cientificas y Tecnicas (CONICET), Buenos Aires, Argentina
| | - Roy Freeman
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
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Dauphinot V, Kossovsky MP, Gueyffier F, Pichot V, Gosse P, Roche F, Barthélémy JC. Impaired baroreflex sensitivity and the risks of new-onset ambulatory hypertension, in an elderly population-based study. Int J Cardiol 2013; 168:4010-4. [PMID: 23870644 DOI: 10.1016/j.ijcard.2013.06.080] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 06/03/2013] [Accepted: 06/30/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Impairment of the autonomic nervous system activity may be involved in the development of hypertension. Yet the prognostic values of heart rate variability and baroreflex sensitivity in the risk of new-onset ambulatory hypertension have not been investigated. We sought to assess the relationship between heart rate variability and baroreflex sensitivity parameters and ambulatory hypertension in a community-dwelling elderly cohort. METHODS Normotensive subjects were selected from the PROOF study cohort, including 1011 subjects aged 65 years at baseline. The autonomic nervous system activity was assessed through 24-hour heart rate variability and 15-minute spontaneous baroreflex sensitivity at baseline. Incident hypertension was defined with the 24-hour, day-time and night-time ambulatory blood pressure measurements and antihypertensive treatment use, at two-years of follow-up. RESULTS At baseline, 13.7% of subjects developed day-time hypertension, 18.2% developed night-time hypertension and 13.6% developed 24-hour hypertension. Reduced baroreflex sensitivity at baseline was associated with onset of hypertension after adjustment for blood pressure level, C-reactive protein levels and depression score (OR = 0.45 [0.23-0.86]). Indices of heart rate variability were not associated with hypertension onset. CONCLUSION Baroreflex sensitivity may represent an intermediate goal for prevention of ambulatory hypertension at early stage.
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Affiliation(s)
- Virginie Dauphinot
- Memory Research Center Lyon, Hôpital des Charpennes, Hospices Civils de Lyon, University Medical Hospital, Lyon, France.
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Bulum T, Blaslov K, Duvnjak L. Resting heart rate is associated with nonproliferative retinopathy in normoalbuminuric type 1 diabetic patients. J Clin Hypertens (Greenwich) 2013; 15:579-83. [PMID: 23889721 DOI: 10.1111/jch.12130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 04/06/2013] [Accepted: 04/14/2013] [Indexed: 11/27/2022]
Abstract
Previous studies have reported that retinopathy might be already present in the normoalbuminuric state in type 1 diabetic patients. The aim of this study was to evaluate the prevalence and predictors of nonproliferative retinopathy in normoalbuminuric type 1 diabetic patients. The study included 312 normoalbuminuric type 1 diabetic patients with normal renal function before any interventions with statins, angiotensin-converting enzyme inhibitors, or angiotensin II receptor blockers. Diagnosis of nonproliferative retinopathy was made by fundoscopy after pupillary dilatation. Urinary albumin excretion (UAE) rate was measured from at least two 24-hour urine samples. Nonproliferative retinopathy was present in 36% of normoalbuminuric patients. Patients with nonproliferative retinopathy were older and had longer duration of diabetes, higher hemoglobin A1c , daily insulin dose, and higher resting heart rate (RHR) (P≤.01 for all). Patients in the 4th quartile of RHR were older and had longer duration of diabetes, higher hemoglobin A1c , daily insulin dose, serum creatinine, UAE, and a significantly higher prevalence of nonproliferative retinopathy compared with subjects in the 2nd, 3rd, and 4th quartiles (P<.05). In logistic regression analysis, after adjustment for risk factors, higher RHR was significantly associated with risk of nonproliferative retinopathy in patients (P<.001), with odds ratios of 1.02 to 1.08. These data suggest that RHR is independently associated with nonproliferative retinopathy in normoalbuminuric type 1 diabetic patients.
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Affiliation(s)
- Tomislav Bulum
- Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, University Hospital Merkur, Medical School, University of Zagreb, Zagreb, Croatia.
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Pop-Busui R, Cleary PA, Braffett BH, Martin CL, Herman WH, Low PA, Lima JAC, Bluemke DA. Association between cardiovascular autonomic neuropathy and left ventricular dysfunction: DCCT/EDIC study (Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications). J Am Coll Cardiol 2012; 61:447-454. [PMID: 23265339 DOI: 10.1016/j.jacc.2012.10.028] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 10/23/2012] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The goal of these studies was to determine the association between cardiovascular autonomic neuropathy (CAN) and indices of left ventricle (LV) structure and function in patients with type 1 diabetes (T1DM) in the DCCT/EDIC (Diabetes Control and Complications Trial /Epidemiology of Diabetes Interventions and Complications) study. BACKGROUND The pathophysiology of LV dysfunction in T1DM remains unclear, especially when the LV ejection fraction (EF) is preserved. Whether CAN is associated with LV dysfunction is unclear. METHODS Indices of LV structure and function were obtained by cardiac magnetic resonance imaging (CMRI). CAN was assessed by cardiovascular reflex testing (R-R response to paced breathing, Valsalva ratio, and blood pressure response to standing). Analyses were performed in 966 DCCT/EDIC participants with valid CMRI and CAN data (mean age 51 years, 52% men, mean diabetes duration 29 years, and mean glycosylated hemoglobin 7.9%). RESULTS Systolic function (EF, end-systolic and end-diastolic volumes, stroke volumes) was not different in 371 subjects with CAN compared with 595 subjects without CAN. In multiple-adjusted analyses, participants with either abnormal R-R variation or a composite of abnormal R-R variation, abnormal Valsalva ratio, and postural blood pressure changes had significantly higher LV mass, mass-to-volume-ratio, and cardiac output compared with those with normal tests (p < 0.0001 for all). After further adjustment for traditional cardiovascular risk factors, subjects with abnormal R-R variation had higher LV mass and cardiac output compared with those with a normal R-R variation (p < 0.05). CONCLUSIONS In this large cohort of patients with T1DM, CAN is associated with increased LV mass and concentric remodeling as assessed by CMRI independent of age, sex, and other factors. (Diabetes Control and Complications Trial [DCCT]; NCT00360815) (Epidemiology of Diabetes Interventions and Complications [EDIC]; NCT00360893).
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Affiliation(s)
- Rodica Pop-Busui
- Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, Michigan.
| | - Patricia A Cleary
- Biostatistics Center, George Washington University, Rockville, Maryland
| | | | - Catherine L Martin
- Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, Michigan
| | - William H Herman
- Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, Michigan
| | - Phillip A Low
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - Joao A C Lima
- Division of Cardiology, Johns Hopkins University, Baltimore, Maryland
| | - David A Bluemke
- Radiology and Imaging Sciences, National Center for Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, Maryland
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[Relationships between baroreflex gain and pulsatile stress in type 1 diabetic patients]. Ann Cardiol Angeiol (Paris) 2012; 61:178-83. [PMID: 22575439 DOI: 10.1016/j.ancard.2012.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 04/04/2012] [Indexed: 02/07/2023]
Abstract
AIM OF THE STUDY Cardiovascular autonomic neuropathy (CAN) and early arterial stiffness are frequent complications in type 1 diabetes. The aim of our work is to study the relationships between CAN (estimated by baroreflex gain calculation) and arterial stiffness (estimated by pulsatile stress) in type 1 diabetic patients. PATIENTS AND METHODS In a cross-sectional study, we calculated baroreflex gain and pulsatile stress in 167 type 1 diabetic patients and 160 matched non-diabetic subjects whose blood pressure was continuously monitored with a Finapres(®) device in a postural test (squatting test). The baroreflex gain was calculated by plotting the pulse intervals (R-R) against systolic blood pressure values during the transition phase from squatting to standing. Pulsatile stress was estimated by the pulse pressure×heart rate product. In a longitudinal study, the baroreflex gain and pulsatile stress were calculated before and after a mean follow-up of 79±33 months in type 1 diabetic patients. RESULTS Cross-sectional data showed a decrease in baroreflex gain and an increase in pulsatile stress in type 1 diabetic patients versus the matched non-diabetic subjects. A significant correlation between the baroreflex gain and pulsatile stress was present. Type 1 diabetic patients with lower baroreflex gain had a higher value of pulsatile stress when compared to those with higher baroreflex gain. During follow-up, a significant reduction in baroreflex gain (but without significantly increased pulsatile stress) was observed. A univariate analysis showed that the decrease of the baroreflex gain is not correlated with the time interval between the two tests, neither type 1 diabetes duration nor mean glycated hemoglobin values, but significantly with the pulsatile stress increase. CONCLUSION In type 1 diabetic patients, the baroreflex gain is decreased and the pulsatile stress is increased when these markers are compared to age-matched non-diabetic subjects. There is a relationship between indices of CAN and arterial stiffness. Nevertheless, the baroreflex gain (marker of CAN) is impaired earlier than the pulsatile stress in this type 1 diabetic population with inadequate glycaemic control.
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