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Relationship between autonomic neuropathy and hypertension-are we underestimating the problem?

Background  Cardiac autonomic neuropathy (CAN) is associated with significant morbidity and mortality in diabetes and the risk is even greater in those with hypertension. Aims  The aim of our study was to investigate the relationship between CAN and 24‐h blood pressure profile in normoalbuminuric pa...

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Published in:Diabetic medicine 2008-07, Vol.25 (7), p.863-866
Main Authors: Istenes, I., Keresztes, K., Hermányi, Z., Putz, Z., Vargha, P., Gandhi, R., Tesfaye, S., Kempler, P.
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container_issue 7
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container_title Diabetic medicine
container_volume 25
creator Istenes, I.
Keresztes, K.
Hermányi, Z.
Putz, Z.
Vargha, P.
Gandhi, R.
Tesfaye, S.
Kempler, P.
description Background  Cardiac autonomic neuropathy (CAN) is associated with significant morbidity and mortality in diabetes and the risk is even greater in those with hypertension. Aims  The aim of our study was to investigate the relationship between CAN and 24‐h blood pressure profile in normoalbuminuric patients with Type 2 diabetes mellitus. Methods  Seventy patients with Type 2 diabetes (31 without CAN, 39 with CAN), who had no history of hypertension, and 29 healthy volunteers underwent five standard cardiovascular reflex tests to assess autonomic function and 24‐h ambulatory blood pressure monitoring. Results  Twenty‐four‐hour mean systolic blood pressure, blood pressure load and hyperbaric impact values were significantly higher in diabetic patients with CAN compared with control subjects and diabetic patients without CAN (P  20%, P 
doi_str_mv 10.1111/j.1464-5491.2008.02458.x
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Aims  The aim of our study was to investigate the relationship between CAN and 24‐h blood pressure profile in normoalbuminuric patients with Type 2 diabetes mellitus. Methods  Seventy patients with Type 2 diabetes (31 without CAN, 39 with CAN), who had no history of hypertension, and 29 healthy volunteers underwent five standard cardiovascular reflex tests to assess autonomic function and 24‐h ambulatory blood pressure monitoring. Results  Twenty‐four‐hour mean systolic blood pressure, blood pressure load and hyperbaric impact values were significantly higher in diabetic patients with CAN compared with control subjects and diabetic patients without CAN (P < 0.05). In spite of normal clinic blood pressures, 54% of diabetic subjects with CAN and 29% without CAN were hypertensive (systolic blood pressure load > 20%, P < 0.05). In the diabetes group as a whole, Valsalva ratio, postural systolic blood pressure changes and diastolic blood pressure responses during sustained handgrip correlated significantly and negatively with 24‐h mean systolic blood pressure (P < 0.01, P < 0.001, P < 0.05) and blood pressure load (P < 0.05, P < 0.001, P < 0.05). Conclusions  Cardiovascular autonomic neuropathy is independently associated with hypertension in normoalbuminuric Type 2 diabetic patients with no history of hypertension. Relying on clinic blood pressures in subjects with CAN could lead to a failure to diagnose hypertension in over half of cases. All normotensive patients with CAN should be screened for hypertension using ambulatory blood pressure monitoring in order to institute early aggressive interventions to improve their long‐term outlook.]]></description><identifier>ISSN: 0742-3071</identifier><identifier>EISSN: 1464-5491</identifier><identifier>DOI: 10.1111/j.1464-5491.2008.02458.x</identifier><identifier>PMID: 18513306</identifier><identifier>CODEN: DIMEEV</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>Adult ; Aged ; Biological and medical sciences ; Blood Pressure Monitoring, Ambulatory ; cardiovascular autonomic neuropathy ; Case-Control Studies ; Cross-Sectional Studies ; diabetes mellitus ; Diabetes Mellitus, Type 2 - complications ; Diabetes. Impaired glucose tolerance ; Diabetic Angiopathies - complications ; Diabetic Neuropathies - complications ; Endocrine pancreas. Apud cells (diseases) ; Endocrinopathies ; Etiopathogenesis. Screening. Investigations. Target tissue resistance ; Feeding. Feeding behavior ; Female ; Fundamental and applied biological sciences. Psychology ; Heart Diseases - complications ; Humans ; hypertension ; Hypertension - complications ; Male ; Medical sciences ; Middle Aged ; Vertebrates: anatomy and physiology, studies on body, several organs or systems ; Vertebrates: endocrinology</subject><ispartof>Diabetic medicine, 2008-07, Vol.25 (7), p.863-866</ispartof><rights>2008 The Authors. Journal compilation © 2008 Diabetes UK</rights><rights>2008 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5328-ec8384e9edd5d543ef7b72090b60afa2990a18a94be85daba2dbdba5319834f03</citedby><cites>FETCH-LOGICAL-c5328-ec8384e9edd5d543ef7b72090b60afa2990a18a94be85daba2dbdba5319834f03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=20494255$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18513306$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Istenes, I.</creatorcontrib><creatorcontrib>Keresztes, K.</creatorcontrib><creatorcontrib>Hermányi, Z.</creatorcontrib><creatorcontrib>Putz, Z.</creatorcontrib><creatorcontrib>Vargha, P.</creatorcontrib><creatorcontrib>Gandhi, R.</creatorcontrib><creatorcontrib>Tesfaye, S.</creatorcontrib><creatorcontrib>Kempler, P.</creatorcontrib><title>Relationship between autonomic neuropathy and hypertension-are we underestimating the problem?</title><title>Diabetic medicine</title><addtitle>Diabet Med</addtitle><description><![CDATA[Background  Cardiac autonomic neuropathy (CAN) is associated with significant morbidity and mortality in diabetes and the risk is even greater in those with hypertension. Aims  The aim of our study was to investigate the relationship between CAN and 24‐h blood pressure profile in normoalbuminuric patients with Type 2 diabetes mellitus. Methods  Seventy patients with Type 2 diabetes (31 without CAN, 39 with CAN), who had no history of hypertension, and 29 healthy volunteers underwent five standard cardiovascular reflex tests to assess autonomic function and 24‐h ambulatory blood pressure monitoring. Results  Twenty‐four‐hour mean systolic blood pressure, blood pressure load and hyperbaric impact values were significantly higher in diabetic patients with CAN compared with control subjects and diabetic patients without CAN (P < 0.05). In spite of normal clinic blood pressures, 54% of diabetic subjects with CAN and 29% without CAN were hypertensive (systolic blood pressure load > 20%, P < 0.05). In the diabetes group as a whole, Valsalva ratio, postural systolic blood pressure changes and diastolic blood pressure responses during sustained handgrip correlated significantly and negatively with 24‐h mean systolic blood pressure (P < 0.01, P < 0.001, P < 0.05) and blood pressure load (P < 0.05, P < 0.001, P < 0.05). Conclusions  Cardiovascular autonomic neuropathy is independently associated with hypertension in normoalbuminuric Type 2 diabetic patients with no history of hypertension. Relying on clinic blood pressures in subjects with CAN could lead to a failure to diagnose hypertension in over half of cases. All normotensive patients with CAN should be screened for hypertension using ambulatory blood pressure monitoring in order to institute early aggressive interventions to improve their long‐term outlook.]]></description><subject>Adult</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Blood Pressure Monitoring, Ambulatory</subject><subject>cardiovascular autonomic neuropathy</subject><subject>Case-Control Studies</subject><subject>Cross-Sectional Studies</subject><subject>diabetes mellitus</subject><subject>Diabetes Mellitus, Type 2 - complications</subject><subject>Diabetes. Impaired glucose tolerance</subject><subject>Diabetic Angiopathies - complications</subject><subject>Diabetic Neuropathies - complications</subject><subject>Endocrine pancreas. Apud cells (diseases)</subject><subject>Endocrinopathies</subject><subject>Etiopathogenesis. Screening. Investigations. Target tissue resistance</subject><subject>Feeding. Feeding behavior</subject><subject>Female</subject><subject>Fundamental and applied biological sciences. 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Impaired glucose tolerance</topic><topic>Diabetic Angiopathies - complications</topic><topic>Diabetic Neuropathies - complications</topic><topic>Endocrine pancreas. Apud cells (diseases)</topic><topic>Endocrinopathies</topic><topic>Etiopathogenesis. Screening. Investigations. Target tissue resistance</topic><topic>Feeding. Feeding behavior</topic><topic>Female</topic><topic>Fundamental and applied biological sciences. Psychology</topic><topic>Heart Diseases - complications</topic><topic>Humans</topic><topic>hypertension</topic><topic>Hypertension - complications</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Vertebrates: anatomy and physiology, studies on body, several organs or systems</topic><topic>Vertebrates: endocrinology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Istenes, I.</creatorcontrib><creatorcontrib>Keresztes, K.</creatorcontrib><creatorcontrib>Hermányi, Z.</creatorcontrib><creatorcontrib>Putz, Z.</creatorcontrib><creatorcontrib>Vargha, P.</creatorcontrib><creatorcontrib>Gandhi, R.</creatorcontrib><creatorcontrib>Tesfaye, S.</creatorcontrib><creatorcontrib>Kempler, P.</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Neurosciences Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Diabetic medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Istenes, I.</au><au>Keresztes, K.</au><au>Hermányi, Z.</au><au>Putz, Z.</au><au>Vargha, P.</au><au>Gandhi, R.</au><au>Tesfaye, S.</au><au>Kempler, P.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Relationship between autonomic neuropathy and hypertension-are we underestimating the problem?</atitle><jtitle>Diabetic medicine</jtitle><addtitle>Diabet Med</addtitle><date>2008-07</date><risdate>2008</risdate><volume>25</volume><issue>7</issue><spage>863</spage><epage>866</epage><pages>863-866</pages><issn>0742-3071</issn><eissn>1464-5491</eissn><coden>DIMEEV</coden><abstract><![CDATA[Background  Cardiac autonomic neuropathy (CAN) is associated with significant morbidity and mortality in diabetes and the risk is even greater in those with hypertension. Aims  The aim of our study was to investigate the relationship between CAN and 24‐h blood pressure profile in normoalbuminuric patients with Type 2 diabetes mellitus. Methods  Seventy patients with Type 2 diabetes (31 without CAN, 39 with CAN), who had no history of hypertension, and 29 healthy volunteers underwent five standard cardiovascular reflex tests to assess autonomic function and 24‐h ambulatory blood pressure monitoring. Results  Twenty‐four‐hour mean systolic blood pressure, blood pressure load and hyperbaric impact values were significantly higher in diabetic patients with CAN compared with control subjects and diabetic patients without CAN (P < 0.05). In spite of normal clinic blood pressures, 54% of diabetic subjects with CAN and 29% without CAN were hypertensive (systolic blood pressure load > 20%, P < 0.05). In the diabetes group as a whole, Valsalva ratio, postural systolic blood pressure changes and diastolic blood pressure responses during sustained handgrip correlated significantly and negatively with 24‐h mean systolic blood pressure (P < 0.01, P < 0.001, P < 0.05) and blood pressure load (P < 0.05, P < 0.001, P < 0.05). Conclusions  Cardiovascular autonomic neuropathy is independently associated with hypertension in normoalbuminuric Type 2 diabetic patients with no history of hypertension. Relying on clinic blood pressures in subjects with CAN could lead to a failure to diagnose hypertension in over half of cases. All normotensive patients with CAN should be screened for hypertension using ambulatory blood pressure monitoring in order to institute early aggressive interventions to improve their long‐term outlook.]]></abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>18513306</pmid><doi>10.1111/j.1464-5491.2008.02458.x</doi><tpages>4</tpages></addata></record>
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subjects Adult
Aged
Biological and medical sciences
Blood Pressure Monitoring, Ambulatory
cardiovascular autonomic neuropathy
Case-Control Studies
Cross-Sectional Studies
diabetes mellitus
Diabetes Mellitus, Type 2 - complications
Diabetes. Impaired glucose tolerance
Diabetic Angiopathies - complications
Diabetic Neuropathies - complications
Endocrine pancreas. Apud cells (diseases)
Endocrinopathies
Etiopathogenesis. Screening. Investigations. Target tissue resistance
Feeding. Feeding behavior
Female
Fundamental and applied biological sciences. Psychology
Heart Diseases - complications
Humans
hypertension
Hypertension - complications
Male
Medical sciences
Middle Aged
Vertebrates: anatomy and physiology, studies on body, several organs or systems
Vertebrates: endocrinology
title Relationship between autonomic neuropathy and hypertension-are we underestimating the problem?
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