[An analysis of the cardiovascular maneuvers for the diagnosis of cardiovascular autonomic neuropathy].

Fifteen reflex tests for the diagnosis of cardiovascular autonomic neuropathy (CAN) were evaluated in 90 controls and 154 diabetic patients. We found that age, baseline heart rate and body position differently influenced the tests. The best parasympathetic indexes were Valsalva, inspiration minus expiration (I-E) and orthostatism indexes. We found minimal normality values for the three indexes, in individuals below age 50 years and in those aged 50 years or more, of 1.35 and 1.14, 12 and 7, and 1.16 and 1.12, respectively. Parasympathetic neuropathy was more common (68%) and it preceded the sympathetic (3%). CAN developed in 44% of the diabetics without neuropathy, in 63% of those without peripheral neuropathy, and in 84% of those with autonomic symptoms. CAN is associated with neuropathy lasting for more than 10 years.