Association between cardiac autonomic neuropathy and hypertension and its potential influence on diabetic complications
Association between cardiac autonomic neuropathy and hypertension and its potential influence on diabetic complications
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DOI：
10.1111/j.1464-5491.2010.03027.x
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发表时间：
2010-07-01
影响因子：
3.5
通讯作者：
Valensi, P.
中科院分区：
文献类型：
--
作者：
Ayad, F.;Belhadj, M.;Valensi, P.
目的探讨心脏自主神经病变与高血压之间的关系及其在糖尿病并发症中的作用。心脏自主神经病变进行了评估，分析在三个标准的测试（深呼吸，躺在站立和Valsalva）的心率变化，并寻找体位性hypertension.ResultsCardiac自主神经病变存在于123例，39也有高血压。心脏自主神经病变/高血压相关性的患病率在2型患者中更高（P < 0.002）。高血压患病率随心脏自主神经病变严重程度的增加而增加。多因素Logistic回归分析显示，心脏自主神经病变是高血压的独立危险因素[OR 2.86（1.54-5.32）; P < 0.001]。只有确诊或严重的心脏自主神经病变（分别为两项或两项以上的功能检查异常）是高血压的独立危险因素（P < 0.005和< 0.0001）。心脏自主神经病变见于大血管并发症、视网膜病变或肾病的大多数患者，但绝大多数患有这些并发症的患者表现出心脏自主神经病变/高血压特征。这种情况在有冠状动脉或外周动脉疾病或既往卒中的患者中比无这些并发症的患者更常见（P < 0.001）。在Logistic回归分析中，心脏自主神经病变/高血压的档案显着相关的宏观和微血管并发症conclusionsThese数据是强烈支持心脏自主神经病变的作用，在糖尿病患者的高血压。心脏自主神经病变/高血压特征与血管并发症的相关性与对血管血流动力学和结构的有害影响一致，除高血压的影响外。
P>AimsTo examine the association between cardiac autonomic neuropathy and hypertension and the role of this association in diabetic complications.MethodsWe included 310 patients, 138 with Type 1 and 172 with Type 2 diabetes, 62 of them with hypertension. Cardiac autonomic neuropathy was assessed by analysing heart rate variations during three standard tests (deep breathing, lying to standing and Valsalva) and looking for postural hypotension.ResultsCardiac autonomic neuropathy was present in 123 patients and 39 also had hypertension. The prevalence of a cardiac autonomic neuropathy/hypertension association was higher in Type 2 patients (P < 0.002). The prevalence of hypertension increased with the severity of cardiac autonomic neuropathy. In multiple logistic regression analysis, cardiac autonomic neuropathy was an independent risk factor for hypertension [odds ratio 2.86 (1.54-5.32); P < 0.001]. Only confirmed or severe cardiac autonomic neuropathy (two or more abnormal function tests, respectively) were independent risk factors for hypertension (P < 0.005 and < 0.0001). Cardiac autonomic neuropathy was found in most of the patients with macrovascular complications, retinopathy or nephropathy, but a large majority of the patients with these complications exhibited the cardiac autonomic neuropathy/hypertension profile. This profile was more prevalent among the patients with coronary or peripheral artery disease or antecedent stroke than among those free of these complications (P < 0.001). In logistic regression analyses, the cardiac autonomic neuropathy/hypertension profile associated significantly with macro- and microvascular complications.ConclusionsThese data are strongly in favour of the role of cardiac autonomic neuropathy in hypertension in diabetic patients. The association of the cardiac autonomic neuropathy/hypertension profile with vascular complications is consistent with a deleterious effect on vascular hemodynamics and structure, additional to the effects of hypertension.