Diabetes Center, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece.
Cardiovascular Prevention and Research Unit, Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece.
J Hum Hypertens. 2018 Sep;32(8-9):531-539. doi: 10.1038/s41371-018-0070-1. Epub 2018 May 23.
The main aim of this cross-sectional study was to investigate the association between pulse pressure amplification (PPA) and cardiac autonomic activity (baroreflex sensitivity (BRS) and heart rate variability (HRV)) in patients with type 2 diabetes mellitus (T2DM). In addition, we examined the association between cardiac autonomic activity and central hemodynamic parameters that may affect PPA such as augmentation index (AIx), aortic stiffness (pulse wave velocity (PWV)), and common carotid artery stiffness distensibility coefficient (DC). A total of 142 patients with T2DM were included in the study. In multivariate linear regression analysis-after controlling for age, diabetes duration, height, waist circumference, aortic PWV, use of β-blockers, and BRS-PPA was associated significantly and independently with male gender (standardized regression coefficient (β) = 0.156, p = 0.007), aortic systolic blood pressure (β = -0.221, p < 0.001), heart rate (β = 0.521, p < 0.001), AΙx (β = -0.443, p < 0.001), and parameters of HRV, such as total power of HRV (β = -0.157, p = 0.005). No significant associations were found between BRS or parameters of HRV with aortic PWV, AIx, or DC. In patients with T2DM, cardiac autonomic dysfunction was associated with enhanced PPA. This association was independent from the well-described effect of resting heart rate, as well as from traditional cardiovascular risk factors or diabetes-related factors. Moreover, it was not mediated by effects of the autonomic dysfunction on arterial stiffness or on pressure wave reflections. These findings suggest that cardiac autonomic dysfunction affects PPA by mechanisms other than resting tachycardia and arterial properties.
本横断面研究的主要目的是探讨 2 型糖尿病（T2DM）患者脉压放大（PPA）与心脏自主活动（压力反射敏感性（BRS）和心率变异性（HRV））之间的关系。此外，我们还研究了心脏自主活动与可能影响 PPA 的中心血液动力学参数之间的关系，这些参数包括增强指数（AIx）、主动脉僵硬度（脉搏波速度（PWV））和颈总动脉僵硬度扩张系数（DC）。本研究共纳入 142 例 T2DM 患者。在多元线性回归分析中 - 在控制年龄、糖尿病病程、身高、腰围、主动脉 PWV、β受体阻滞剂使用和 BRS 后，PPA 与男性性别显著且独立相关（标准化回归系数（β）= 0.156，p = 0.007）、主动脉收缩压（β = -0.221，p < 0.001）、心率（β = 0.521，p < 0.001）、AIx（β = -0.443，p < 0.001）和 HRV 的参数，如 HRV 的总功率（β = -0.157，p = 0.005）。BRS 或 HRV 的参数与主动脉 PWV、AIx 或 DC 之间无显著相关性。在 T2DM 患者中，心脏自主神经功能障碍与增强的 PPA 相关。这种相关性独立于静息心率的已知影响，以及传统心血管危险因素或糖尿病相关因素。此外，它不受自主神经功能障碍对动脉僵硬度或压力波反射的影响的介导。这些发现表明，心脏自主神经功能障碍通过静息心动过速和动脉特性以外的机制影响 PPA。
