Department of Internal Medicine, University Hospital, Oran, Algeria.
Diabet Med. 2010 Jul;27(7):804-11. doi: 10.1111/j.1464-5491.2010.03027.x.
To examine the association between cardiac autonomic neuropathy and hypertension and the role of this association in diabetic complications.
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.
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.
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.
探讨心脏自主神经病变与高血压的关系以及这种关系在糖尿病并发症中的作用。
我们纳入了 310 名患者，其中 138 名 1 型糖尿病患者，172 名 2 型糖尿病患者，其中 62 名患者患有高血压。通过分析三种标准测试（深呼吸、平卧站立和瓦尔萨尔瓦动作）期间的心率变化以及寻找体位性低血压来评估心脏自主神经病变。
123 名患者存在心脏自主神经病变，其中 39 名患者同时患有高血压。2 型糖尿病患者中，心脏自主神经病变/高血压相关性的发生率更高（P<0.002）。随着心脏自主神经病变的严重程度增加，高血压的发生率也随之增加。在多因素逻辑回归分析中，心脏自主神经病变是高血压的独立危险因素[比值比 2.86（1.54-5.32）；P<0.001]。只有确诊或严重的心脏自主神经病变（分别为两种或更多异常功能测试）是高血压的独立危险因素（P<0.005 和<0.0001）。在存在大血管并发症、视网膜病变或肾病的患者中，大多数患者都存在心脏自主神经病变，但大多数存在这些并发症的患者都存在心脏自主神经病变/高血压特征。与没有这些并发症的患者相比，患有冠状动脉或外周动脉疾病或既往中风的患者中这种特征更为常见（P<0.001）。在逻辑回归分析中，心脏自主神经病变/高血压特征与大血管和微血管并发症显著相关。
这些数据强烈支持心脏自主神经病变在糖尿病患者高血压中的作用。心脏自主神经病变/高血压特征与血管并发症的关联与血管血流动力学和结构的有害影响一致，除了高血压的影响之外。
