Graduate School of Health Sciences, Kobe University, Kobe 654-0142, Japan.
Department of Rehabilitation, Arima Onsen Hospital, Kobe 651-1401, Japan.
Int J Environ Res Public Health. 2019 Mar 6;16(5):812. doi: 10.3390/ijerph16050812.
Few reports have evaluated the relationship between changes in postprandial blood pressure and the severity of autonomic dysfunction in patients with type 2 diabetes. This was a cross-sectional study designed to investigate postprandial blood pressure changes in individuals without type 2 diabetes and patients with type 2 diabetes and mild or severe cardiac autonomic dysfunction. Forty patients with type 2 diabetes mellitus and 20 individuals without type 2 diabetes participated in this study. Fifty-two participants underwent a meal tolerance test. Blood pressure (brachial systolic blood pressure (bSBP) and central systolic blood pressure (cSBP)), electrocardiogram recordings, and blood samples were assessed before and after meal ingestion. Patients with diabetes were divided into two groups based on their coefficient of variation of R⁻R intervals (CVRR): a normal or mildly dysfunctional group (mild group, CVRR ≥ 2%; = 20) and a severely dysfunctional group (severe group, CVRR < 2%; = 15). In the control group, bSBP and cSBP did not significantly change after meal ingestion, whereas both decreased significantly at 60 min after meal ingestion in the mild and severe groups. While blood pressure recovered at 120 min after meal ingestion in the mild group, a significant decrease in blood pressure persisted at 120 min after meal ingestion in the severe group. Based on these results, adequate clinical attention should be paid to the risk of serious events related to postprandial decreases in blood pressure, particularly in patients with diabetes and severe cardiac autonomic dysfunction.
很少有报道评估 2 型糖尿病患者餐后血压变化与自主神经功能障碍严重程度之间的关系。本研究为横断面研究，旨在探讨无 2 型糖尿病个体及伴轻、重度心脏自主神经功能障碍的 2 型糖尿病患者的餐后血压变化。共有 40 例 2 型糖尿病患者和 20 例非 2 型糖尿病个体参与本研究。52 例参与者行口服糖耐量试验。在进餐后测量血压（肱动脉收缩压（bSBP）和中心动脉收缩压（cSBP））、心电图记录和血样。根据 R⁻R 间期变异系数（CVRR）将糖尿病患者分为两组：正常或轻度功能障碍组（轻度组，CVRR≥2%；n=20）和重度功能障碍组（重度组，CVRR<2%；n=15）。在对照组，餐后 bSBP 和 cSBP 无明显变化，而在轻、重度组，餐后 60 min 时均显著降低。在轻度组，餐后 120 min 时血压恢复，但重度组餐后 120 min 时血压仍显著降低。基于这些结果，应对与餐后血压降低相关的严重事件风险给予充分的临床关注，尤其是糖尿病伴重度心脏自主神经功能障碍的患者。
