Journal of the Chinese Medical Association
Volume 69, Issue 6 , Pages 254-258, June 2006

Decrease Heart Rate Variability But Preserve Postural Blood Pressure Change in Type 2 Diabetes with Microalbuminuria

  • Harn-Shen Chen

      Affiliations

    • Division of Endocrinology and Metabolism, Department of Medicine, Taipei, Taiwan, R.O.C.
    • National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • ,
  • Tzu-En Wu

      Affiliations

    • National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • ,
  • Tjin-Shing Jap

      Affiliations

    • Section of Biochemistry, Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • ,
  • Shen-Hung Lee

      Affiliations

    • Division of Endocrinology and Metabolism, Department of Medicine, Taipei, Taiwan, R.O.C.
    • ,
  • Mei-Li Wang

      Affiliations

    • Division of Endocrinology and Metabolism, Department of Medicine, Taipei, Taiwan, R.O.C.
    • ,
  • Ron-A Lu

      Affiliations

    • Division of Endocrinology and Metabolism, Department of Medicine, Taipei, Taiwan, R.O.C.
    • ,
  • Ru-Lin Chen

      Affiliations

    • Division of Endocrinology and Metabolism, Department of Medicine, Taipei, Taiwan, R.O.C.
    • ,
  • Hong-Da Lin

      Affiliations

    • Division of Endocrinology and Metabolism, Department of Medicine, Taipei, Taiwan, R.O.C.
    • National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • Corresponding Author InformationCorrespondence to: Dr. Hong-Da Lin, Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei 112, Taiwan, R.O.C.

Received 28 November 2005; accepted 27 April 2006.

Background

This study compares the cardiovascular autonomic function in type 2 diabetes with and without microalbuminuria, in order to identify the possible links between early nephropathy and diabetic autonomic neuropathy (DAN).

Methods

Cardiovascular reflex tests were performed to determine the cardiovascular autonomic function. Thirty cases of type 2 diabetes with microalbuminuria were studied for evidence of DAN to compare with a normoalbuminuric group of 56 diabetic patients.

Results

There was an increased prevalence of autonomic dysfunction in patients with microalbuminuria (63.3% in the microalbuminuria group vs. 40.0% in the normoalbuminuric controls, p = 0.001). These patients had lower heart rate variability during single breathing tests (6.9 ± 4.3 vs. 9.6 ± 3.6 beats/minute, p = 0.005), during 6 consecutive breathings (5.8 ± 3.6 vs. 8.2 ± 3.3 beats/minute, p = 0.005), after standing up (12.2 ± 4.6 vs. 15.0 ± 5.2 beats/minute, p = 0.012), and during the Valsalva maneuver (11.3 ± 3.5 vs. 13.2 ± 3.6 beats/minute, p = 0.022). The heart rate variability with these stresses was revealed to be less favorable in subjects with microalbuminuria. However, blood pressure (BP) changes from the sitting to standing position were not significantly different for systolic BP (11.5 ± 10.7 vs. 10.7 ± 7.8 mmHg, p = 0.741) and diastolic BP (5.2 ± 4.4 vs. 5.9 ± 4.0 mmHg, p = 0.451) between the 2 groups.

Conclusion

Type 2 diabetic patients with microalbuminuria have diminished heart rate variability in response to deep breathing, change of position and the Valsalva maneuver, but they preserve BP response to postural change. Therefore, microalbuminuria seems to be associated with early DAN, but not with advanced DAN.

Key Words:  cardiovascular reflex tests , diabetic autonomic neuropathy , glycated hemoglobin (A1C) , microalbuminuria , type 2 diabetes

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PII: S1726-4901(09)70252-7

doi:10.1016/S1726-4901(09)70252-7

Journal of the Chinese Medical Association
Volume 69, Issue 6 , Pages 254-258, June 2006

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