ABSTRACT
Background: Diabetes and hypertension are known to co-exist frequently as adverse cardiovascular risk factors. Both can produce cardiac autonomic neuropathythat can be measured by ECG RR interval-based heart rate variability (HRV). We compared 5 minutes HRV in four groups based on diabetes and hypertension. Methodology: A cross sectional study was done on 203 participants divided into four groups- diabetics, hypertensives, diabetic-hypertensives and normotensive-nondiabetics. They were evaluated for current disease control and five minutes HRV was done in supine condition following standard protocols by Variowin HR Software. HRV parameters of time domain, frequency domain and Poincare plot were compared between groups and associated with gender, glycaemic control and blood pressure control. Statistical significance was set at p<0.05. Results: Three diseasedgroups had mean age in mid-fifties, mean duration of disease > 6 years, comparable BMI, poor glycaemic and blood pressure control. As compared to normal groups, three diseased groups exhibit reduced HRV with respect to all three domains of HRV with varying statistical significance. Among diseased groups, HRV was associated with blood pressure control better than glycaemic control but not with gender. LF /HF ratio was the most consistent HRV parameter showing statistical significance in tests. Conclusion: HRV is reduced in both diabetics more than hypertensives; related to blood pressure control more than glycaemic control. It points altered cardiac autonomic balance, and possibility of cardiovascular risk and early detection of it with timely intervention. It also calls for investigation of same for reinforcement of our observations and further exploration.
ABSTRACT
Background: Obesity and vascular ageing are two facets of type 2 diabetes (T2Ds) to study. The former can be studied by qualitative body fat analysis using bio-electrical impedance (BIA) and later with blood pressure by pulse wave analysis (PWA). We studied the association between BIA and PWA parameters in T2Ds. Methodology: One hundred and fifty-six T2Ds on treatment were evaluated for BIA (Omron Karada Scan, China) and PWA (IEM, Stolberg, Germany). BIA parameters (weight, BMI, total body fat, visceral fat, subcutaneous fat, skeletal muscle mass) and PWA parameters (arterial stiffness, brachial haemodynamics, aortic blood pressures, central haemodynamics) were studied. Comparison, correlation, risk association, and predictions were done with a p-value < 0.05 as statistically significant. Results: The mean age was 57.7 years, while the mean BMI was 22.8 kg/m2. The prevalence of hypertension was 50%, while the prevalence of glycaemic control was 10%. The correlation between BIA and PWA parameters in >75% instants was weak and insignificant (especially for aortic parameters and central haemodynamics). Female gender, BMI < 22.5 kg/m2, VF< 10, and low/normal TBF were associated with comparatively high PWA parameters, but inconsistently. High BMI or VF did not impose a significant Odds risk of high aortic pulse wave velocity or central pulse pressure. Visceral fat and aortic pulse wave velocities were not significantly predicted by blood pressure, BMI, and heart rate. Conclusion: Among rural type 2 diabetics with a mean BMI of 22.8 kg/m2 and poor glycaemic control, there is largely a lack of association between obesity and vascular aging, suggesting differences in time course and pathology of the two entities in type 2 diabetics. Further studies are recommended.
