Bassi Daniela, Cabiddu Ramona, Mendes Renata G, Tossini Natália, Arakelian Vivian M, Caruso Flávia C R, Bonjorno Júnior José C, Arena Ross, Borghi-Silva Audrey
Departamento de Fisioterapia, Universidade Ceuma, São Luís, MA - Brazil.
Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, SP - Brazil.
Arq Bras Cardiol. 2018 Jul;111(1):64-72. doi: 10.5935/abc.20180105.
Type 2 diabetes Mellitus (T2DM) is associated with cardiac autonomic dysfunction, which is an independent predictor of mortality in chronic diseases. However, whether the coexistence of systemic arterial hypertension (HTN) with DMT2 alters cardiac autonomic modulation remains unknown.
To evaluate the influence of HTN on cardiac autonomic modulation and cardiorespiratory fitness in subjects with DMT2.
60 patients of both genders were evaluated and allocated to two groups: DMT2 patients (n = 32; 51 ± 7.5 years old) and DMT2 + HTN patients (n = 28; 51 ± 6.9 years old). RR intervals were obtained during rest in supine position. Linear and nonlinear indices of heart rate variability (HRV) were computed using Kubios HRV software. Pulmonary gas exchange was measured breath-by-breath, using a portable telemetric system during maximal incremental exercise testing on a cycle ergometer. Statistical analysis included Shapiro-Wilk test followed by Student's t Test, Pearson correlation and linear regression.
We found that patients in the DMT2+HTN group showed lower values of mean RR intervals (801.1 vs 871.5 ms), Shannon entropy (3 vs 3.2) and fractal dimension SD 1 (9.5 vs 14.5), when contrasted with patients in the DMT2 group. Negative correlations were found between some HRV nonlinear indices and exercise capacity indices.
HTN negatively affects the cardiac autonomic function in diabetic patients, who are already prone to develop autonomic dysfunction. Strategies are need to improve cardiac autonomic functionality in this population.
2型糖尿病（T2DM）与心脏自主神经功能障碍相关，心脏自主神经功能障碍是慢性疾病死亡率的独立预测因素。然而，系统性动脉高血压（HTN）与T2DM共存是否会改变心脏自主神经调节尚不清楚。
评估HTN对T2DM患者心脏自主神经调节和心肺适能的影响。
对60名男女患者进行评估并分为两组：T2DM患者（n = 32；51±7.5岁）和T2DM + HTN患者（n = 28；51±6.9岁）。在仰卧位休息时获取RR间期。使用Kubios HRV软件计算心率变异性（HRV）的线性和非线性指标。在卧式测力计上进行最大递增运动测试期间，使用便携式遥测系统逐次呼吸测量肺气体交换。统计分析包括Shapiro-Wilk检验，随后进行Student's t检验、Pearson相关性分析和线性回归分析。
我们发现，与T2DM组患者相比，T2DM + HTN组患者的平均RR间期值较低（801.1对871.5毫秒）、香农熵较低（3对3.2）以及分形维数SD1较低（9.5对14.5）。在一些HRV非线性指标与运动能力指标之间发现了负相关性。
HTN对已经容易发生自主神经功能障碍的糖尿病患者的心脏自主神经功能有负面影响。需要采取策略来改善该人群的心脏自主神经功能。
