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Pulse pressure and cardiovascular autonomic neuropathy according to duration of type 1 diabetes.
Diabetes Metab Res Rev. 2009 Jul; 25(5):442-51.DM

Abstract

BACKGROUND

To evaluate changes in pulse pressure (PP) and markers of cardiovascular autonomic neuropathy (CAN) according to duration of type 1 diabetes mellitus (T1DM).

METHODS

This cross-sectional controlled study evaluated 159 diabetic patients during a 3-min posture test (standing-squatting-standing) with continuous measurement of systolic (SBP), diastolic (DBP) and mean (MBP) blood pressure by a Finapres device. Arterial stiffness was indirectly assessed by PP and the slope of PP as a function of MBP calculated during the whole 3-min test. CAN was assessed by the expiration/inspiration pulse interval ratio (E/I R-R ratio) during deep breathing and by three indices measured during the squatting test. Patients were divided into four groups according to diabetes duration (<10 years, 11-20 years, 21-30 years and > 30 years from group 1 to group 4, respectively) and compared with age-matched non-diabetic subjects.

RESULTS

PP progressively increased (p < 0.0001) and PP/MBP decreased (p < 0.0005) according to T1DM duration, whereas these parameters remained almost unchanged in age-matched control subjects. E/I ratio (p < 0.0001) and baroreflex gain (p < 0.0005) progressively decreased with T1DM duration. The parasympathetic index (squatting test vagal ratio-SqTv) significantly increased (p < 0.0001), whereas the sympathetic index (squatting test sympathetic ratio-SqTs) only tended to decrease (p = 0.12) according to diabetes duration. No such changes in CAN indices were observed in the non-diabetic population.

CONCLUSIONS

PP increased according to T1DM duration in an age range where PP remained almost stable in controls, in agreement with accelerated arterial stiffening due to chronic hyperglycaemia. The baroreflex gain decreased and other indices of CAN also deteriorated with diabetes duration, more so indices reflecting parasympathetic rather than sympathetic dysfunction.

Authors+Show Affiliations

Division of Diabetes, Nutrition and Metabolic Disorders, Department of Medicine, CHU Sart Tilman, Liège, Belgium.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19437445

Citation

Philips, J C., et al. "Pulse Pressure and Cardiovascular Autonomic Neuropathy According to Duration of Type 1 Diabetes." Diabetes/metabolism Research and Reviews, vol. 25, no. 5, 2009, pp. 442-51.
Philips JC, Marchand M, Scheen AJ. Pulse pressure and cardiovascular autonomic neuropathy according to duration of type 1 diabetes. Diabetes Metab Res Rev. 2009;25(5):442-51.
Philips, J. C., Marchand, M., & Scheen, A. J. (2009). Pulse pressure and cardiovascular autonomic neuropathy according to duration of type 1 diabetes. Diabetes/metabolism Research and Reviews, 25(5), 442-51. https://doi.org/10.1002/dmrr.969
Philips JC, Marchand M, Scheen AJ. Pulse Pressure and Cardiovascular Autonomic Neuropathy According to Duration of Type 1 Diabetes. Diabetes Metab Res Rev. 2009;25(5):442-51. PubMed PMID: 19437445.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pulse pressure and cardiovascular autonomic neuropathy according to duration of type 1 diabetes. AU - Philips,J C, AU - Marchand,M, AU - Scheen,A J, PY - 2009/5/14/entrez PY - 2009/5/14/pubmed PY - 2009/11/3/medline SP - 442 EP - 51 JF - Diabetes/metabolism research and reviews JO - Diabetes Metab Res Rev VL - 25 IS - 5 N2 - BACKGROUND: To evaluate changes in pulse pressure (PP) and markers of cardiovascular autonomic neuropathy (CAN) according to duration of type 1 diabetes mellitus (T1DM). METHODS: This cross-sectional controlled study evaluated 159 diabetic patients during a 3-min posture test (standing-squatting-standing) with continuous measurement of systolic (SBP), diastolic (DBP) and mean (MBP) blood pressure by a Finapres device. Arterial stiffness was indirectly assessed by PP and the slope of PP as a function of MBP calculated during the whole 3-min test. CAN was assessed by the expiration/inspiration pulse interval ratio (E/I R-R ratio) during deep breathing and by three indices measured during the squatting test. Patients were divided into four groups according to diabetes duration (<10 years, 11-20 years, 21-30 years and > 30 years from group 1 to group 4, respectively) and compared with age-matched non-diabetic subjects. RESULTS: PP progressively increased (p < 0.0001) and PP/MBP decreased (p < 0.0005) according to T1DM duration, whereas these parameters remained almost unchanged in age-matched control subjects. E/I ratio (p < 0.0001) and baroreflex gain (p < 0.0005) progressively decreased with T1DM duration. The parasympathetic index (squatting test vagal ratio-SqTv) significantly increased (p < 0.0001), whereas the sympathetic index (squatting test sympathetic ratio-SqTs) only tended to decrease (p = 0.12) according to diabetes duration. No such changes in CAN indices were observed in the non-diabetic population. CONCLUSIONS: PP increased according to T1DM duration in an age range where PP remained almost stable in controls, in agreement with accelerated arterial stiffening due to chronic hyperglycaemia. The baroreflex gain decreased and other indices of CAN also deteriorated with diabetes duration, more so indices reflecting parasympathetic rather than sympathetic dysfunction. SN - 1520-7560 UR - https://www.unboundmedicine.com/medline/citation/19437445/Pulse_pressure_and_cardiovascular_autonomic_neuropathy_according_to_duration_of_type_1_diabetes_ L2 - https://doi.org/10.1002/dmrr.969 DB - PRIME DP - Unbound Medicine ER -