Brahimi M, Dabire H, Platon P, Hadj-Brahim F, Attali J R, Valensi P
Service d'endocrinologie-diabétologie-nutrition, Hôpital Jean-Verdier, Bondy.
Arch Mal Coeur Vaiss. 2001 Aug;94(8):944-6.
An increase in arterial rigidity is associated with a poor cardiovascular prognosis. Several studies have suggested that an increase in sympathetic activity may be involved in essential hypertension. We have recently shown that vagal control of heart rate (HR) variations during standardised tests is altered in normotensive obese and diabetic patients. The aim of the present study was to compare cardiovascular vagosympathetic activity in obese and type 2 diabetic patients, either normotensive or hypertensive, and to investigate the relationship between pulse pressure (an index of arterial rigidity) and sympathetic activity in this population. Seventy normotensive obese and 32 mildly hypertensive obese patients, 18 normotensive type 2 diabetic patients and 14 mildly hypertensive type 2 diabetic patients were compared with 21 control subjects. Finapres studied HR and blood pressure variations. In the four groups, during a 6-min period at a controlled breathing rate, the high frequency peak of HR variations was significantly reduced (p < 0.001). The mid-frequency peak of systolic BP variations in the standing position, which depends on sympathetic activity, did not differ significantly between the four groups and control subjects. In obese and diabetic hypertensive patients, this peak correlated significantly with pulse pressure measured in the lying position (r = 0.379; p = 0.043 and r = 0.81; p < 0.0001, respectively). This study 1, confirms that vagal control of HR variations is reduced to a similar extent in obese and diabetic patients; and 2, suggests that cardiovascular sympathetic activity is relatively increased in these patients without significant difference between normotensive and hypertensive patients, but interestingly that the increase in arterial rigidity is associated with a higher sympathetic activity.
动脉僵硬度增加与不良的心血管预后相关。多项研究表明，交感神经活动增加可能与原发性高血压有关。我们最近发现，在标准化测试期间，正常血压的肥胖和糖尿病患者心率（HR）变异性的迷走神经控制发生了改变。本研究的目的是比较肥胖和2型糖尿病患者（无论血压正常与否）的心血管迷走交感神经活动，并研究该人群中脉压（动脉僵硬度指标）与交感神经活动之间的关系。将70名血压正常的肥胖患者和32名轻度高血压肥胖患者、18名血压正常的2型糖尿病患者和14名轻度高血压2型糖尿病患者与21名对照受试者进行比较。Finapres监测心率和血压变化。在四组中，在以控制呼吸频率进行的6分钟期间，心率变异性的高频峰值显著降低（p < 0.001）。取决于交感神经活动的站立位收缩压变异性的中频峰值在四组与对照受试者之间无显著差异。在肥胖和糖尿病高血压患者中，该峰值与卧位测量的脉压显著相关（分别为r = 0.379；p = 0.043和r = 0.81；p < 0.0001）。本研究1. 证实肥胖和糖尿病患者心率变异性的迷走神经控制在相似程度上降低；2. 表明这些患者的心血管交感神经活动相对增加，血压正常和高血压患者之间无显著差异，但有趣的是，动脉僵硬度增加与更高的交感神经活动相关。
