Diabetic Cardiovascular Autonomic Neuropathy, the Handgrip Test and Ambulatory Blood Pressure Monitoring Parameters: Are There Any Diagnostic Implications?
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 hype...
Main Authors: | , , , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
MDPI AG
2020-10-01
|
Series: | Journal of Clinical Medicine |
Subjects: | |
Online Access: | https://www.mdpi.com/2077-0383/9/10/3322 |
id |
doaj-79695a1145c94b5885f22b407861425f |
---|---|
record_format |
Article |
spelling |
doaj-79695a1145c94b5885f22b407861425f2020-11-25T03:37:35ZengMDPI AGJournal of Clinical Medicine2077-03832020-10-0193322332210.3390/jcm9103322Diabetic Cardiovascular Autonomic Neuropathy, the Handgrip Test and Ambulatory Blood Pressure Monitoring Parameters: Are There Any Diagnostic Implications?Miklós Kempler0Noémi Hajdú1Zsuzsanna Putz2Ildikó Istenes3Orsolya Vági4Magdolna Békeffy5Karolina Schnabel6Péter Kempler7Anna E. Körei8Department of Internal Medicine and Haematology, Semmelweis University, Szentkirályi street 46, 1088 Budapest, HungaryDepartment of Internal Medicine and Oncology, Semmelweis University, Korányi Sándor street 2/a, 1083 Budapest, HungaryDepartment of Internal Medicine and Oncology, Semmelweis University, Korányi Sándor street 2/a, 1083 Budapest, HungaryDepartment of Internal Medicine and Oncology, Semmelweis University, Korányi Sándor street 2/a, 1083 Budapest, HungaryDepartment of Internal Medicine and Oncology, Semmelweis University, Korányi Sándor street 2/a, 1083 Budapest, HungaryDepartment of Internal Medicine and Oncology, Semmelweis University, Korányi Sándor street 2/a, 1083 Budapest, HungaryDepartment of Internal Medicine and Oncology, Semmelweis University, Korányi Sándor street 2/a, 1083 Budapest, HungaryDepartment of Internal Medicine and Oncology, Semmelweis University, Korányi Sándor street 2/a, 1083 Budapest, HungaryDepartment of Internal Medicine and Oncology, Semmelweis University, Korányi Sándor street 2/a, 1083 Budapest, HungaryCardiovascular 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, <i>p</i> = 0.003), daytime (rho = 0.230, <i>p</i> = 0.005) and night-time (rho = 0.230, <i>p</i> = 0.006) mean systolic and 24-h diastolic (rho = 0.176, <i>p</i> = 0.034) blood pressure values, systolic blood pressure load (rho = 0.252, <i>p</i> = 0.003) and systolic (rho = 0.236, <i>p</i> = 0.005) and diastolic (rho = 0.165, <i>p</i> = 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.https://www.mdpi.com/2077-0383/9/10/3322cardiovascular autonomic neuropathyhandgrip testhypertension |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Miklós Kempler Noémi Hajdú Zsuzsanna Putz Ildikó Istenes Orsolya Vági Magdolna Békeffy Karolina Schnabel Péter Kempler Anna E. Körei |
spellingShingle |
Miklós Kempler Noémi Hajdú Zsuzsanna Putz Ildikó Istenes Orsolya Vági Magdolna Békeffy Karolina Schnabel Péter Kempler Anna E. Körei Diabetic Cardiovascular Autonomic Neuropathy, the Handgrip Test and Ambulatory Blood Pressure Monitoring Parameters: Are There Any Diagnostic Implications? Journal of Clinical Medicine cardiovascular autonomic neuropathy handgrip test hypertension |
author_facet |
Miklós Kempler Noémi Hajdú Zsuzsanna Putz Ildikó Istenes Orsolya Vági Magdolna Békeffy Karolina Schnabel Péter Kempler Anna E. Körei |
author_sort |
Miklós Kempler |
title |
Diabetic Cardiovascular Autonomic Neuropathy, the Handgrip Test and Ambulatory Blood Pressure Monitoring Parameters: Are There Any Diagnostic Implications? |
title_short |
Diabetic Cardiovascular Autonomic Neuropathy, the Handgrip Test and Ambulatory Blood Pressure Monitoring Parameters: Are There Any Diagnostic Implications? |
title_full |
Diabetic Cardiovascular Autonomic Neuropathy, the Handgrip Test and Ambulatory Blood Pressure Monitoring Parameters: Are There Any Diagnostic Implications? |
title_fullStr |
Diabetic Cardiovascular Autonomic Neuropathy, the Handgrip Test and Ambulatory Blood Pressure Monitoring Parameters: Are There Any Diagnostic Implications? |
title_full_unstemmed |
Diabetic Cardiovascular Autonomic Neuropathy, the Handgrip Test and Ambulatory Blood Pressure Monitoring Parameters: Are There Any Diagnostic Implications? |
title_sort |
diabetic cardiovascular autonomic neuropathy, the handgrip test and ambulatory blood pressure monitoring parameters: are there any diagnostic implications? |
publisher |
MDPI AG |
series |
Journal of Clinical Medicine |
issn |
2077-0383 |
publishDate |
2020-10-01 |
description |
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, <i>p</i> = 0.003), daytime (rho = 0.230, <i>p</i> = 0.005) and night-time (rho = 0.230, <i>p</i> = 0.006) mean systolic and 24-h diastolic (rho = 0.176, <i>p</i> = 0.034) blood pressure values, systolic blood pressure load (rho = 0.252, <i>p</i> = 0.003) and systolic (rho = 0.236, <i>p</i> = 0.005) and diastolic (rho = 0.165, <i>p</i> = 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. |
topic |
cardiovascular autonomic neuropathy handgrip test hypertension |
url |
https://www.mdpi.com/2077-0383/9/10/3322 |
work_keys_str_mv |
AT mikloskempler diabeticcardiovascularautonomicneuropathythehandgriptestandambulatorybloodpressuremonitoringparametersarethereanydiagnosticimplications AT noemihajdu diabeticcardiovascularautonomicneuropathythehandgriptestandambulatorybloodpressuremonitoringparametersarethereanydiagnosticimplications AT zsuzsannaputz diabeticcardiovascularautonomicneuropathythehandgriptestandambulatorybloodpressuremonitoringparametersarethereanydiagnosticimplications AT ildikoistenes diabeticcardiovascularautonomicneuropathythehandgriptestandambulatorybloodpressuremonitoringparametersarethereanydiagnosticimplications AT orsolyavagi diabeticcardiovascularautonomicneuropathythehandgriptestandambulatorybloodpressuremonitoringparametersarethereanydiagnosticimplications AT magdolnabekeffy diabeticcardiovascularautonomicneuropathythehandgriptestandambulatorybloodpressuremonitoringparametersarethereanydiagnosticimplications AT karolinaschnabel diabeticcardiovascularautonomicneuropathythehandgriptestandambulatorybloodpressuremonitoringparametersarethereanydiagnosticimplications AT peterkempler diabeticcardiovascularautonomicneuropathythehandgriptestandambulatorybloodpressuremonitoringparametersarethereanydiagnosticimplications AT annaekorei diabeticcardiovascularautonomicneuropathythehandgriptestandambulatorybloodpressuremonitoringparametersarethereanydiagnosticimplications |
_version_ |
1724545113881837568 |