Hypertension Contributes to Neuropathy in Patients With Type 1 Diabetes
Hypertension Contributes to Neuropathy in Patients With Type 1 Diabetes
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DOI：
10.1093/ajh/hpz058
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发表时间：
2019-08-01
影响因子：
3.2
通讯作者：
Malik, Rayaz A.
中科院分区：
文献类型：
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作者：
Ponirakis, Georgios;Petropoulos, Ioannis N.;Malik, Rayaz A.
背景糖尿病周围神经病变（DPN）可导致足部溃疡和截肢。目前没有DPN的疾病修饰疗法。方法对70例1型糖尿病（T1DM）患者和78例对照者进行DPN综合评估。在T1DM患者中，高血压与神经传导参数异常（P = 0.03至< 0.001）、振动感知阈值升高（P = 0.01）以及角膜神经纤维密度和长度降低（P = 0.02）相关。然而，在调整混杂因素后，只有胫骨复合运动动作电位和神经传导速度与高血压（P = 0.03）和收缩压（P < 0.01至< 0.0001）相关。高血压对无糖尿病患者的神经病变无影响。结论：本研究表明，高血压与T1DM患者的神经传导受损有关。它支持以前的小型试验表明，血管紧张素转换酶抑制剂改善神经传导，并主张需要更大的临床试验与降压药物在DPN。
BACKGROUND Diabetic peripheral neuropathy (DPN) can lead to foot ulceration and amputation. There are currently no disease-modifying therapies for DPN. The aim of this study was to determine if hypertension contributes to DPN in patients with type 1 diabetes mellitus (T1DM).METHODS Subjects with T1DM (n = 70) and controls (n = 78) underwent a comprehensive assessment of DPN.RESULTS Hypertension was present in 40 of 70 T1DM subjects and 20 of 78 controls. Hypertension was associated with abnormal nerve conduction parameters (P = 0.03 to < 0.001), increased vibration perception threshold (P = 0.01) and reduced corneal nerve fiber density and length (P = 0.02) in subjects with T1DM. However, after adjusting for confounding factors only tibial compound motor action potential and nerve conduction velocity were associated with hypertension (P = 0.03) and systolic blood pressure (P < 0.01 to < 0.0001). Hypertension had no effect on neuropathy in subjects without diabetes.CONCLUSIONS This study shows that hypertension is associated with impaired nerve conduction in T1DM. It supports previous small trials showing that angiotensin-converting enzyme inhibitors improve nerve conduction and advocates the need for larger clinical trials with blood pressure lowering agents in DPN.