Abstract
Cardiovascular autonomic neuropathy (CAN) is a common complication of diabetes mellitus. Cardiovascular reflex tests (CARTs) are the gold standard in the diagnosis of CAN, but the handgrip test is no longer recommended to be performed. Previously, the inverse association between the presence of hypertension and handgrip test abnormality was demonstrated and hypertension as major cause for excessive diastolic blood pressure rise during handgrip testing in diabetic individuals proposed. The aim of the present study is to describe more precisely the association between handgrip test and hypertension by performing ambulatory blood pressure monitoring (ABPM) among diabetic patients. A more comprehensive evaluation of the relationship between cardiovascular autonomic function, hypertension and the handgrip test was targeted using heart rate variability (HRV) analysis. Our study involved 163 patients with diabetes. Cardiovascular autonomic neuropathy was assessed by the CARTs and sustained handgrip test was performed. All patients underwent ABPM and HRV analysis well. CAN was diagnosed in 69 patients. Significant associations were found between the diastolic blood pressure increase in response to handgrip exercise and the 24-h (rho = 0.245, p = 0.003), daytime (rho = 0.230, p = 0.005) and night-time (rho = 0.230, p = 0.006) mean systolic and 24-h diastolic (rho = 0.176, p = 0.034) blood pressure values, systolic blood pressure load (rho = 0.252, p = 0.003) and systolic (rho = 0.236, p = 0.005) and diastolic (rho = 0.165, p = 0.047) hyperbaric impacts. Higher values of ambulatory blood pressure monitoring parameters are associated with greater increases in diastolic blood pressure during isometric handgrip exercise. Diastolic blood pressure elevations during the handgrip test are also correlated, in order to diminished heart rate variability parameters attributable to parasympathetic dysfunction highlighting the pivotal role of sympathetic overactivity in evolving handgrip test results. Our study provides further evidence on the inverse association between handgrip test abnormality and hypertension in diabetic patients.
Highlights
Cardiovascular autonomic neuropathy (CAN) is a common complication of diabetes mellitus [1] and it has been reported to be associated with increased cardiovascular morbidity and mortality in diabetic patients [2,3].early and correct diagnosis of CAN cannot be overstated
In our recent study involving over 350 patients with diabetes, we proved that sustained handgrip test has a poor sensitivity and specificity against the diagnosis of confirmed CAN and no associations with results of other cardiovascular reflex rests (CARTs) could be demonstrated
Higher values of ambulatory blood pressure monitoring (ABPM) parameters are associated with greater increases in diastolic blood pressure during isometric handgrip exercise
Summary
Cardiovascular autonomic neuropathy (CAN) is a common complication of diabetes mellitus [1] and it has been reported to be associated with increased cardiovascular morbidity and mortality in diabetic patients [2,3].early and correct diagnosis of CAN cannot be overstated. Cardiovascular autonomic neuropathy (CAN) is a common complication of diabetes mellitus [1] and it has been reported to be associated with increased cardiovascular morbidity and mortality in diabetic patients [2,3]. Standard cardiovascular reflex rests (CARTs) are the most widely used in clinical practice. CARTs are safe, non-invasive, easy-to-perform tests and considered gold standard of CAN assessment [4]. A set of five standard CARTs including the handgrip test were used to assess CAN among diabetic patients. The measurement of diastolic blood pressure elevation in response to sustained handgrip exercise (handgrip test) has been no longer suggested to be performed [1,4]. There were no previous studies designed to judge the clinical relevance of the handgrip test and analysing its confounders in diabetic patients
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