Journal
AMERICAN JOURNAL OF PHYSIOLOGY-REGULATORY INTEGRATIVE AND COMPARATIVE PHYSIOLOGY
Volume 302, Issue 5, Pages R541-R550Publisher
AMER PHYSIOLOGICAL SOC
DOI: 10.1152/ajpregu.00174.2011
Keywords
autonomic neuropathy; spectral power; baroreflex sensitivity; baroreflex effectiveness index; power spectral density
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Funding
- nih (NIH) [RO1 NS39774]
- Kentucky NASA EPSCOR [WKU 52611]
- UK GCRC USPHS [M01RR-02602]
- University of Kentucky NIH CTSA [UL1RR-033173]
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Wang S, Randall DC, Knapp CF, Patwardhan AR, Nelson KR, Karounos DG, Evans JM. Blood pressure regulation in diabetic patients with and without peripheral neuropathy. Am J Physiol Regul Integr Comp Physiol 302: R541-R550, 2012. First published November 2, 2011; doi:10.1152/ajpregu.00174.2011.-Cardiac and vascular dysfunctions resulting from autonomic neuropathy (AN) are complications of diabetes, often undiagnosed. Our objectives were to: 1) determine sympathetic and parasympathetic components of compromised blood pressure (BP) regulation in patients with peripheral neuropathy and 2) rank noninvasive indexes for their sensitivity in diagnosing AN. We continuously measured electrocardiogram, arterial BP, and respiration during supine rest and 70 degrees head-up tilt in 12 able-bodied subjects, 7 diabetics without, 7 diabetics with possible, and 8 diabetics with definite, sensory, and/or motor neuropathy (D2). During the first 3 min of tilt, systolic BP (SBP) of D2 decreased [-10.9 +/- 4.5 (SE) mmHg] but increased in able-bodied (+4.8 +/- 5.4 mmHg). Compared with able-bodied, D2 had smaller low-frequency (0.04-0.15 Hz) spectral power of diastolic BP, lower baroreflex effectiveness index (BEI), and more SBP ramps. Except for low-frequency power of SBP, D2 had greater SBP and smaller RR interval harmonic and nonharmonic components at rest across the 0.003- to 0.45-Hz region. In addition, our results support previous findings of smaller HF RR interval power, smaller numbers of baroreflex sequences, and lower baroreflex sensitivity in D2. We conclude that diabetic peripheral neuropathy is accompanied by diminished parasympathetic and sympathetic control of heart rate and peripheral vasomotion and diminished baroreflex regulation. A novel finding of this study lies in the sensitivity of BEI to detect AN, presumably because of its combination of parameters that measure reductions in both sympathetic control of vasomotion and parasympathetic control of heart rate.
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