Relations entre gain baroréflexe et autres marqueurs de risque chez le patient diabétique de type 2

Abstract

Aim of the studyThe present work is studying the relationships between baroreflex gain (BRG), pulse pressure (PP) and estimated glomerular filtration rate (eGFR) in type 2 diabetic (T2D) patients. Patients and methodsA continuous non-invasive monitoring (Finapres®) of blood pressure (BP) and heart rate (HR) during a standardized postural manoeuvre (squatting test) was performed in 64 T2D patients allowing the calculation of BRG during the squatting to standing transition and the increase in PP during the standing to squatting transition. eGFR was calculated using the MDRD formula and glycated haemoglobin (HbA1c) was measured at baseline and after a follow-up of 12±5 years. ResultsWhen compared to patients with a high BRG (n=30), patients with a low BRG (n=34) were slightly older, but had a similar sex ratio and comparable duration of diabetes, HbA1c level and BP values. They had a higher baseline HR, a greater elevation of PP during squatting and a more pronounced BP fall when standing up, with delayed BP recovery and a less marked tachycardia. While eGFR was significantly lower at baseline in patients with low BRG, the subsequent reduction in eGFR during the 12 years of follow-up was comparable between the two groups. ConclusionA low BRG, a marker of cardiac autonomic neuropathy, is associated with a higher PP in squatting position, a marker of arterial fitness, and a reduction in eGFR (nephropathy), but does not predict the subsequent deterioration of renal function.