|
 |
|
|||||||
|
|||||||||
© 2003 by the American Diabetes Association, Inc.
Pathophysiology/Complications |
Spectrum of Autonomic Cardiovascular Neuropathy in Diabetes
1 J. Recanati Autonomic Dysfunction Center, Rambam Medical Center, Haifa, Israel
2 Departments of Medicine and Pharmacology, Autonomic Dysfunction Center, Vanderbilt University, Nashville, Tennessee
Address correspondence and reprint requests to Italo Biaggioni, MD, Clinical Trials Center, 1500 21st Ave. South, Suite 3500, Vanderbilt University, Nashville, TN 37212. E-mail: italo.biaggioni{at}vanderbilt.edu.
OBJECTIVE—Diabetic patients with incapacitating orthostatic hypotension can have either a "hyperadrenergic" or "hypoadrenergic" presentation. Although the latter is related to overt autonomic neuropathy, the former is proposed to be explained by appropriate autonomic responses. We hypothesize, however, that both conditions are part of a spectrum of autonomic dysfunction.
RESEARCH DESIGN AND METHODS—We studied 16 consecutive diabetic patients with preserved renal function referred for incapacitating orthostatic hypotension and characterized their autonomic and neurohumoral cardiovascular regulation.
RESULTS—Six patients had a hyperadrenergic orthostatic response: systolic blood pressure fell 42 ± 15 mmHg, heart rate increased 20 ± 3 bpm, and plasma norepinephrine increased from 340 ± 80 to 910 ± 100 pg/ml. Ten patients had a hypoadrenergic response: systolic blood pressure fell 78 ± 5 mmHg, heart rate increased only 7 ± 3 bpm, and norepinephrine increased only from 130 ± 28 to 230 ± 40 pg/ml. Vagal (sinus arrhythmia, Valsalva ratio) and sympathetic (response to hyperventilation, postprandial hypotension) responses were impaired in both groups, but to a greater extent in the hypoadrenergic group. Notwithstanding severe orthostatic hypotension, the postural increase in plasma renin was blunted in both groups, more so in the hypoadrenergic group. Despite preserved renal function, patients had mild anemia due to impaired erythropoietin release, as seen in primary cases of autonomic failure.
CONCLUSIONS—Our results suggest that diabetic patients presenting with hyperadrenergic orthostatic hypotension have an initial stage of autonomic neuropathy, with overtly abnormal vagal function and early signs of sympathetic impairment. Furthermore, altered renin response can contribute to the patients’ orthostatic hypotension.
CiteULike 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
This article has been cited by other articles:
|
|
 |
|
  D Gupta and M D Nair Neurogenic orthostatic hypotension: chasing "the fall" Postgrad. Med. J., January 1, 2008; 84(987): 6 - 14. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Shibao, S. R. Raj, A. Gamboa, A. Diedrich, L. Choi, B. K. Black, D. Robertson, and I. Biaggioni Norepinephrine Transporter Blockade With Atomoxetine Induces Hypertension in Patients With Impaired Autonomic Function Hypertension, July 1, 2007; 50(1): 47 - 53. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Shibao, A. Gamboa, A. Diedrich, C. Dossett, L. Choi, G. Farley, and I. Biaggioni Acarbose, an {alpha}-Glucosidase Inhibitor, Attenuates Postprandial Hypotension in Autonomic Failure Hypertension, July 1, 2007; 50(1): 54 - 61. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. S. Maurer, J. Burcham, and H. Cheng Diabetes Mellitus Is Associated With an Increased Risk of Falls in Elderly Residents of a Long-Term Care Facility J. Gerontol. A Biol. Sci. Med. Sci., September 1, 2005; 60(9): 1157 - 1162. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Shibao, A. Gamboa, A. Diedrich, and I. Biaggioni Management of Hypertension in the Setting of Autonomic Failure: A Pathophysiological Approach Hypertension, April 1, 2005; 45(4): 469 - 476. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| Diabetes | Diabetes Care | Clinical Diabetes | Diabetes Spectrum |