Association between cardiac autonomic neuropathy and hypertension and its potential influence on diabetic complications

Diabet Med. 2010 Jul;27(7):804-11. doi: 10.1111/j.1464-5491.2010.03027.x.

Abstract

Aims: To examine the association between cardiac autonomic neuropathy and hypertension and the role of this association in diabetic complications.

Methods: We included 310 patients, 138 with Type 1 and 172 with Type 2 diabetes, 62 of them with hypertension. Cardiac autonomic neuropathy was assessed by analysing heart rate variations during three standard tests (deep breathing, lying to standing and Valsalva) and looking for postural hypotension.

Results: Cardiac autonomic neuropathy was present in 123 patients and 39 also had hypertension. The prevalence of a cardiac autonomic neuropathy/hypertension association was higher in Type 2 patients (P < 0.002). The prevalence of hypertension increased with the severity of cardiac autonomic neuropathy. In multiple logistic regression analysis, cardiac autonomic neuropathy was an independent risk factor for hypertension [odds ratio 2.86 (1.54-5.32); P < 0.001]. Only confirmed or severe cardiac autonomic neuropathy (two or more abnormal function tests, respectively) were independent risk factors for hypertension (P < 0.005 and < 0.0001). Cardiac autonomic neuropathy was found in most of the patients with macrovascular complications, retinopathy or nephropathy, but a large majority of the patients with these complications exhibited the cardiac autonomic neuropathy/hypertension profile. This profile was more prevalent among the patients with coronary or peripheral artery disease or antecedent stroke than among those free of these complications (P < 0.001). In logistic regression analyses, the cardiac autonomic neuropathy/hypertension profile associated significantly with macro- and microvascular complications.

Conclusions: These data are strongly in favour of the role of cardiac autonomic neuropathy in hypertension in diabetic patients. The association of the cardiac autonomic neuropathy/hypertension profile with vascular complications is consistent with a deleterious effect on vascular hemodynamics and structure, additional to the effects of hypertension.

MeSH terms

  • Adult
  • Algeria / epidemiology
  • Autonomic Nervous System / physiology*
  • Blood Pressure / physiology
  • Body Mass Index
  • Diabetes Complications
  • Diabetes Mellitus, Type 1 / complications
  • Diabetes Mellitus, Type 1 / epidemiology
  • Diabetes Mellitus, Type 1 / physiopathology*
  • Diabetes Mellitus, Type 2 / complications
  • Diabetes Mellitus, Type 2 / epidemiology
  • Diabetes Mellitus, Type 2 / physiopathology*
  • Diabetic Cardiomyopathies / complications
  • Diabetic Cardiomyopathies / epidemiology*
  • Diabetic Neuropathies / epidemiology
  • Diabetic Neuropathies / physiopathology*
  • Female
  • Heart Rate / physiology
  • Humans
  • Hypertension / epidemiology
  • Hypertension / physiopathology*
  • Male
  • Odds Ratio
  • Risk Factors