Takahashi N, Nakagawa M, Saikawa T, Ooie T, Yufu K, Shigematsu S, Hara M, Sakino H, Katsuragi I, Okeda T, Yoshimatsu H, Sakata T
Department of Internal Medicine I, School of Medicine, Oita Medical University, Japan.
J Am Coll Cardiol. 2001 Jul;38(1):232-7. doi: 10.1016/s0735-1097(01)01363-8.
The aim of this study was to examine the effects of essential hypertension on cardiac autonomic function in type 2 diabetic patients.
Hypertension is common in type 2 diabetic patients and is associated with a high mortality. However, the combined effects of type 2 diabetes and essential hypertension on cardiac autonomic function have not been fully elucidated.
Thirty-three patients with type 2 diabetes were assigned to a hypertensive diabetic group (n = 15; age: 56 +/- 8 years, mean +/- SD) or an age-matched normotensive diabetic group (n = 18, 56 +/- 6 years). Cardiac autonomic function was assessed by baroreflex sensitivity (BRS), heart rate variability (HRV), plasma norepinephrine concentration and cardiac 123I-metaiodobenzylguanidine (MIBG) scintigraphic findings.
Baroreflex sensitivity was lower in the hypertensive diabetic group than it was in the normotensive diabetic group (p < 0.05). The early and delayed myocardial uptake of 123I-MIBG was lower (p < 0.01 and p < 0.05, respectively), and the percent washout rate of 123I-MIBG was higher (p < 0.05) in the hypertensive diabetic group. However, the high frequency (HF) power and the ratio of low frequency (LF) power to HF power (LF/HF) of HRV and plasma norepinephrine concentration were not significantly different. The homeostasis model assessment index was higher in the hypertensive diabetic group than it was in the normotensive diabetic group (p < 0.01).
Our results indicate that essential hypertension acts synergistically with type 2 diabetes to depress cardiac reflex vagal and sympathetic function, and the results also suggest that insulin resistance may play a pathogenic role in these processes.
本研究旨在探讨原发性高血压对2型糖尿病患者心脏自主神经功能的影响。
高血压在2型糖尿病患者中很常见，且与高死亡率相关。然而，2型糖尿病和原发性高血压对心脏自主神经功能的联合影响尚未完全阐明。
33例2型糖尿病患者被分为高血压糖尿病组（n = 15；年龄：56±8岁，均值±标准差）或年龄匹配的血压正常糖尿病组（n = 18，56±6岁）。通过压力反射敏感性（BRS）、心率变异性（HRV）、血浆去甲肾上腺素浓度和心脏123I-间碘苄胍（MIBG）闪烁显像结果评估心脏自主神经功能。
高血压糖尿病组的压力反射敏感性低于血压正常糖尿病组（p < 0.05）。高血压糖尿病组123I-MIBG的早期和延迟心肌摄取较低（分别为p < 0.01和p < 0.05），且123I-MIBG的清除率百分比更高（p < 0.05）。然而，HRV的高频（HF）功率以及低频（LF）功率与HF功率之比（LF/HF）和血浆去甲肾上腺素浓度无显著差异。高血压糖尿病组的稳态模型评估指数高于血压正常糖尿病组（p < 0.01）。
我们的结果表明，原发性高血压与2型糖尿病协同作用，抑制心脏反射性迷走神经和交感神经功能，结果还提示胰岛素抵抗可能在这些过程中起致病作用。
