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J Am Coll Cardiol, 2001; 38:232-237
© 2001 by the American College of Cardiology Foundation
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CLINICAL STUDY

Effect of essential hypertension on cardiac autonomic function in type 2 diabetic patients

Naohiko Takahashi, MD*, Mikiko Nakagawa, MD{dagger}, Tetsunori Saikawa, MD{dagger}, Tatsuhiko Ooie, MD*, Kunio Yufu, MD*, Sakuji Shigematsu, MD*, Masahide Hara, MD*, Hiroshi Sakino, MD*, Isao Katsuragi, MD*, Toshimitsu Okeda, MD*, Hironobu Yoshimatsu, MD* and Toshiie Sakata, MD*

* Department of Internal Medicine I, School of Medicine, Oita Medical University, Oita, Japan
{dagger} Department of Laboratory Medicine, School of Medicine, Oita Medical University, Oita, Japan

Manuscript received December 1, 2001; revised manuscript received March 21, 2001, accepted April 5, 2001.

Reprint requests and correspondence: Dr. Naohiko Takahashi, Department of Internal Medicine I, School of Medicine, Oita Medical University, 1-1 Idaigaoka, Hasama, Oita 879-5593, Japan
takanao{at}oita-med.ac.jp

OBJECTIVES

The aim of this study was to examine the effects of essential hypertension on cardiac autonomic function in type 2 diabetic patients.

BACKGROUND

Hypertension is common in type 2 diabetic patients and is associated with a high mortality. However, the combined effects of type 2 diabetes and essential hypertension on cardiac autonomic function have not been fully elucidated.

METHODS

Thirty-three patients with type 2 diabetes were assigned to a hypertensive diabetic group (n = 15; age: 56 ± 8 years, mean ± SD) or an age-matched normotensive diabetic group (n = 18, 56 ± 6 years). Cardiac autonomic function was assessed by baroreflex sensitivity (BRS), heart rate variability (HRV), plasma norepinephrine concentration and cardiac 123I-metaiodobenzylguanidine (MIBG) scintigraphic findings.

RESULTS

Baroreflex sensitivity was lower in the hypertensive diabetic group than it was in the normotensive diabetic group (p < 0.05). The early and delayed myocardial uptake of 123I-MIBG was lower (p < 0.01 and p < 0.05, respectively), and the percent washout rate of 123I-MIBG was higher (p < 0.05) in the hypertensive diabetic group. However, the high frequency (HF) power and the ratio of low frequency (LF) power to HF power (LF/HF) of HRV and plasma norepinephrine concentration were not significantly different. The homeostasis model assessment index was higher in the hypertensive diabetic group than it was in the normotensive diabetic group (p < 0.01).

CONCLUSIONS

Our results indicate that essential hypertension acts synergistically with type 2 diabetes to depress cardiac reflex vagal and sympathetic function, and the results also suggest that insulin resistance may play a pathogenic role in these processes.

Abbreviations and Acronyms
  BRS = baroreflex sensitivity
  ECG = electrocardiogram
  H/M = heart-to-mediastinum
  HF = high frequency component (0.15 to 0.45 Hz)
  HOMA = homeostasis model assessment
  HRV = heart rate variability
  LF = low frequency component (0.04 to 0.15 Hz)
  LV = left ventricular
  MIBG = metaiodobenzylguanidine
  NE = norepinephrine
  WR = washout rate




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