Effects of Coexistence Hypertension and Type II Diabetes on Heart Rate Variability and Cardiorespiratory Fitness

Exploring the Interplay of Smoking Behavior, Heart Rate Variability, Pulmonary Function Test Results, Diabetes, and Mood Disorders: A Systematic Review

This systematic review aimed to collate and analyze findings from various studies that explored the associations between heart rate variability (HRV), smoking behavior, pulmonary function, diabetes, and mood disorders. A comprehensive database search strategy was employed, utilizing medical subject headings terms combined with Boolean operators across seven databases. The review found that conditions such as hypertension and type 2 diabetes exacerbate cardiac autonomic dysfunction, thereby aggravating cardiovascular risks. HRV emerged as a potential early indicator of cardiac morbidity in smokers, with immediate disruptions noted following acute smoking episodes. Furthermore, both pulmonary and cardiac autonomic functions were influenced by the autonomic control of cardiovascular function, independent of smoking status. The findings underscore the importance of HRV as a multifaceted indicator that reflects the health impacts of lifestyle choices, metabolic conditions, and mental health states.

Heart Rate Variability and Respiratory Muscle Strength in Patients With Type II Diabetes Practicing Pilates: A Randomized Clinical Trial

PURPOSE

This study aimed to analyze the effect of a Pilates protocol on respiratory muscle strength and heart rate variability (HRV) in patients with type 2 diabetes.

METHOD

A randomized clinical trial (RBR-2gc2qj) was conducted on a type 2 diabetic target population. Patients practiced the Pilates protocol for 8 weeks, with two visits per week. The variables tested were maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), and HRV (time and frequency domains). All variables were tested for normal distribution. Using SPSS 21.0, analysis of variance was performed for variables with normal distribution, and the Wilcoxon and Friedman tests were used for variables that did not show a normal distribution, with a 5% significance level.

RESULTS

Forty-four participants were included in the study (intervention group: 22; control group: 22; mean age: 61.23 ± 8.49 years), most of whom were female (77.3%), married or in a consensual union (59.1%), had complete literacy (31.8%), and had an average body mass index of 26.96 ± 4.35 kg/m². There were no significant differences in MIP and MEP b efore and after the protocol between the intervention and control groups. Regarding HRV, there were significant differences in autonomic modulation, especially between the moments before and during exercise and between the moments during and after exercise; however, it was not possible to determine which system (sympathetic or parasympathetic) is most involved in these changes.

CONCLUSION

The exercise protocol based on the Pilates method did not alter respiratory muscle strength but promoted changes in HRV, especially between the moments before and during exercise and during and after exercise.

Dynamics of heart rate variability in patients with type 2 diabetes mellitus during spinal anesthesia using dexmedetomidine

Objective The aim of this study was to investigate the heart rate variability (HRV) in patients with Type 2 diabetes mellitus (T2DM) who underwent spinal anesthesia using dexmedetomidine for lower limb surgery.

METHODS

T2DM patients were divided into two groups, namely the controlled group (HbA1c < 7%) and the uncontrolled group (HbA1c > 7%) according to the glycosylated hemoglobin (HbA1c) level, and patients with non-T2DM as the normal group, 30 cases in each group. The HRV, including low-frequency (LF) power, high-frequency (HF) power, total power (TP) and LF/HF ratio, was measured 10 min before spinal anesthesia (T0) and 10 min (T1), 20 min (T2) and 30 min (T3) after spinal anesthesia with dexmedetomidine.

RESULTS

We observed that TP, LF, and HF power in the uncontrolled group were remarkably lower than that in the other two groups at T0 (P < 0.05). In the controlled group, the LF power dropped markedly at T1-2 than the normal group. The LF power in the uncontrolled group did not show significant change at all time points, but was significantly lower than the level in the controlled group at T1-3. The HF power in the three groups did not alter markedly at different time points, but the HF power in the uncontrolled group was markedly lower than that in the normal group and the controlled group. In all three groups, the LF/HF ratio dropped markedly at T1-3 with no markedly difference between the groups. The heart rhythms in the three groups showed a decrease trend after spinal anesthesia with no markedly difference between the groups. The SBP and DBP at T1-3 in the three groups were markedly lower than that at T0, and the systolic blood pressure (SBP) and diastolic blood pressure (DBP) at T1-3 in the uncontrolled group were markedly higher than those in the normal group and the controlled group.

CONCLUSION

Spinal anesthesia with dexmedetomidine affects autonomic nerve function in patients whose glycemic control is better during the lower limb surgery in T2DM patients, but has no significant effect on patients who fail to do so. For such patients, spinal anesthesia can result in a markedly increase in SBP and DBP.

The Association of Autonomic Nervous System Function With Ischemic Stroke, and Treatment Strategies

Acute ischemic stroke, especially minor stroke, and transient ischemic attack have high risks of recurrence and exacerbation into severe ischemic strokes. It remains challenging to perform risk stratification and screen high-risk groups for initiation of early treatment in these patients. Moreover, with the growing population of patients with chronic small vessel disease, the mechanisms and clinical implications require further investigation. Traditional tools such as the ABCD2 score (age, blood pressure, clinical features, duration of symptoms, diabetes) have only moderate predictive value in patients with transient ischemic attack or minor stroke. By contrast, measurement of changes in heart rate variability (HRV) is an important and novel tool for risk stratification and outcome prediction in patients with cardiovascular diseases, as it reflects the overall level of autonomic nervous system dysfunction. Thus, abnormal HRV may be useful for prognosis and improve stratification of stroke patients with diverse risks. HRV may also partially explain autonomic nervous dysfunction and other manifestations during the process of chronic cerebral small vessel disease. In summary, measurement of HRV may contribute to early initiation of interventions in acute or chronic stroke patients using novel treatments involving rebalancing of autonomic nervous system function.

Impact of arterial hypertension and type 2 diabetes on cardiac autonomic modulation in obese individuals with recommendation for bariatric surgery

BACKGROUND AND AIM

Obese individuals with recommendation for bariatric surgery (BS) exhibit increased cardiovascular risk. The association of obesity with comorbidities, such as arterial hypertension (HTN) and type 2 diabetes mellitus (T2DM) can worsen cardiovascular dysfunction. This study aimed to investigate the effect of HTN on cardiac autonomic function and whether diabetes exacerbates HTN-related impairment of autonomic function in obese subjects.

METHODS

Samples (n=63) were allocated to three groups: Obese without HTN and T2DM (n=29), Obese with HTN (OHTN, n=17) and OHTN with T2DM (OHTN+T2DM, n=17), in which anthropometric measures, body composition, blood biochemical parameters, blood pressure (BP) and heart rate variability (HRV) were evaluated.

RESULTS

The age was higher in OHTN+T2DM and OHTN than in obese groups (p<0.05). OHTN+T2DM individuals had increased neck circumference and compromised glycemic profile when compared to obese and OHTN groups (p<0.05). Mean values for standard deviation of RR (SDRR), square root of the mean squared differences of successive RR interval (RMSSD) and number of pairs of successive normal-to-normal beat intervals that differed by 50 ms (pRR50) were significantly lower in OHTN+T2DM and OHTN groups when compared to patients with obesity alone (p<0.05). The low frequency (LF), low frequency/high frequency (LF/HF) ratio were higher in the OHTN+T2DM and OHTN than subjects with obesity alone (p<0.05). Nonlinear parameters SD2 and SD1 were also lower in the OHTN+T2DM when compared to the obese group (p<0.05). However, the SD2/SD1 ratio was higher in the OHTN+T2DM and OHTN groups than the obese group.

CONCLUSION

T2DM and/or HTN impair the cardiac autonomic function in obese patients. However, the presence of T2DM did not exacerbate the hypertension-related impairment of autonomic function.

Inter and Intra-Rater Reliability of Short-Term Measurement of Heart Rate Variability on Rest in Diabetic Type 2 Patients

Heart rate variability (HRV) among other methods can be used to assess diabetic cardiac autonomic neuropathy by cardiac intervals were recorded. However, the amount of error depending on this measurement methodology is unclear. To evaluate the intra- and inter-rater reliability to calculate HRV indices, comparing different times and by different trained examiners in patients with type 2 diabetes mellitus (T2DM). Thirty individuals of both genders, aged between 18 and 45 years, with T2DM. The RR interval (RRi) were recorded during a 10 min period on supine position using a portable heart rate monitor (Polar® S810i model). HRV indices were calculated by the software Kubios® HRV analysis (version 2.2). Linear (Mean RRi; STD RR; Mean HR; rMSSD; RR Tri; TINN LF; HF; total power) and non-linear (SD1; SD2; DFα1; DFα2, ApEn and, SampEn) indices were calculated by two examiners with an interval of one week between them. Substantial to excellent was found for reliability of the intra-examiner, with intraclass correlation coefficient (ICC) values ranging from 0.79 to 0.99, standard error of measurement (SEM) between 0.02 and 123.49 (in percentage: 1.83 and 16.67), and minimum detectable change (MDC) between 0.07 and 342.30. Regarding the inter-examiner reliability, substantial to excellent reliability was found, with ICC values ranging from 0.73 to 0.97, SEM between 0.04 and 178.13 (in percentage: 3.26 and 24.18), and MDC between 0.11 and 493.77. The use of the portable heart rate monitor to measure HRV showed acceptable intra and inter reliability in individuals with T2DM, supporting the use of this method of evaluation in research and clinical practice.