Наукові праці. Кафедра внутрішньої медицини № 1

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Blood pressure dipping status affects the relationship between glucose fluctuation and heart rate variability in type 1 diabetic patients
(2018) Shalimova, Anna; Graff, Beata; Szyndler, Anna; Wolf, Jacek; Blaszkowska, Magdalena; Orlowska-Kunikowska, Elzbieta; Wolnik, Bogumil; Narkiewicz, Krzysztof
Cardiac autonomic neuropathy is a frequent complication of type 1 diabetes (DM1). However, none of the previous study has assessed the inter-relationship between glucose fluctuation, circadian blood pressure rhythm and features of heart rate variability (HRV). The aim: to test the hypothesis that in patients with longstanding DM1 the relationship between HRV and glucose fluctuation is influenced by blood pressure diurnal profile. Methods: We examined 42 subjects with longstanding (>20 years) history of DM1 (without cardiovascular disease, including hypertension). In all patients, simultaneous 24-hour continuous glucose monitoring, ABPM and Holter electrocardiographic recording were performed. Subjects were divided into two groups according to dipping pattern (dippers n=20, non-dippers n=22). Results: Both groups of patients did not differ with respect to duration of hypo-, normo- and hyperglycaemia, while time- and frequency domain HRV parameters were significantly lower in non-dippers (p<0.05). Several HRV parameters including SDANN and LF spectrum power were positively related to duration of hypoglycaemic episodes both in dippers and non-dippers (p<0.05). However, other HRV parameters were associated with glucose fluctuation only in non-dippers. Time of hypoglycaemia was positively related to pNN50, rMSSD, diurnal and night HF spectrum power, in the presence of its negative correlations with 24-hour and day VLF% (p<0.05); time of hyperglycaemia was negatively related to pNN50, rMSSD, 24-hour, day and night ULF, VLF and HF spectrum power (p<0.05). Conclusions: In non-dippers with longstanding DM1, HRV is lower but more sensitive to glucose fluctuation than in dippers.
Blood presure is related to glucose fluctuation in longstanding type 1 diabetes
(2018) Shalimova, Anna; Graff, Beata; Szyndler, Anna; Wolf, Jacek; Blaszkowska, Magdalena; Orlowska-Kunikowska, Elzbieta; Wolnik, Bogumil; Narkiewicz, Krzysztof
Mechanisms underlying relationship between hypertension and metabolic abnormalities are well established in type 2 diabetes. Much less is known about this link in type 1 diabetes. None of the previous studies has assessed relationship between glucose variability and diurnal blood pressure profile in patients with longstanding type 1 diabetes (DM1). The aim: to investigate the possible association of glucose fluctuation with BP levels in longstanding DM1. Design and methods: We examined 36 patients with longstanding (>20 years) history of DM1 (without overt cardiovascular disease, including hypertension) and episodes of hyperglycemia >160 mg/dL during 24-hour continuous glucose monitoring (CGM). In all patients simultaneous 24-hour CGM and ambulatory blood pressure monitoring (ABPM) were performed. Intima-media thickness (IMT) of the common carotid artery was also assessed. Patients were divided into two groups: with and without severe hypoglycemia <50 mg/dL (n=18 in each group). Results: Compared to patients with hypoglycemia, patients without hypoglycemia had a significantly lower day-time SBP variability expressed as standard deviation (12.6 ± 2.5 and 10.9 ± 3.0 mmHg, respectively, p<0.05). In patients without hypoglycemia, mean amplitude of glycemic excursion both up and down was associated with increase in DBP (r=0.49, p<0.05 and r=0.59, p<0.05, respectively), whereas in patients with hypoglycemia it was associated with increase in SBP (r=0.53, p<0.05). In patients without hypoglycemia, time of hyperglycemia was associated with increase in DBP (r=0.57, p<0.05) and in patient with hypoglycemia – with increase in SBP (r=0.67, p<0.05). Furthermore, in patients with short hypoglycemic episodes, time of hypoglycemia was associated with increase in SBP (r=0.57, p<0.05). In patients with hypoglycemia, SBP level had also positive correlation with IMT (r=0.50, p<0.05). Conclusions: In patients with longstanding DM1, BP is related to glucose fluctuation. While the change in glucose levels towards hypoglycemia is associated with an increase in SBP, hyperglycemia is linked to an increase in DBP. The mechanisms underlying these associations remain to be determined.
Circadian rhythm of blood pressure is related with heart rate but not with glucose variability in longstanding type 1 diabetic patients
(2018) Graff, Beata; Shyndler, A; Shalimova, Anna; Wolf, Jacek; Blaszkowska, Magdalena; Orlowska-Kunikowska, Elzbieta; Wolnik, Bogumil; Narkiewicz, Krzysztof
Objective: Non-dipping pattern has been associated with cardiac autonomic neuropathy (CAN) in diabetic patients. However, in normotensive patients with type 1 diabetes (DM1) ambulatory blood pressure monitoring (ABPM) is not routinely performed. Surprisingly, none of the previous studies analyzed the relationship of autonomic regulation, glucose variability and non-dipping status (defi ned as less than 10% night-time blood pressure (BP) drop) in DM1. The aim of the study was to investigate the possible association of circadian BP rhythm with glucose levels and its variability as well as with parameters of autonomic regulation. Design and method: We examined 42 subjects with long-standing (>20 years) history of DM1 (without cardiovascular disease, including hypertension). In all patients, simultaneous 24-hour continuous glucose monitoring (iPro2), ABPM (Spacelabs 90217) and Holter electrocardiographic recording (Medilog Darwin, Schiller) were performed. Time- and frequency heart rate variability (HRV) parameters were used as indicators of cardiovascular autonomic regulation. Subjects were divided into two groups depending on presence of dipping pattern (dippers n = 20, non-dippers n = 22). Results: Groups with dipping and non-dipping pattern did not differ with respect to age, BMI, mean heart rate, mean glucose levels, parameters of glucose variability and its long-term control (HbA1c).
Heart rate variability is related to concomitant glucose fluctuation in longstanding type 1 diabetes
(2018) Shalimova, Anna; Graff, Beata; Szyndler, Anna; Wolf, Jacek; Blaszkowska, Magdalena; Orlowska-Kunikowska, Elzbieta; Wolnik, Bogumil; Narkiewicz, Krzysztof
The presence of type 1 diabetes (DM1) affects the heart rate variability (HRV). However, there are conflicting data on the impact of hyper- and hypoglycaemia on the parameters of cardiovascular autonomic regulation.
Heart rate variability, large vessel remodelling and metabolic parameters in stage 1 hypertension according to the ACC/AHA 2017 guidelines
(2018) Shalimova, Anna; Graff, Beata; Szyndler, Anna; Wolf, Jacek; Blaszkowska, Magdalena; Orlowska-Kunikowska, Elzbieta; Wolnik, Bogumil; Narkiewicz, Krzysztof
Objective: Controversial defi nition of arterial hypertension (AH) by the ACC/AHA 2017 Guidelines renewed interest in the earlier stages of blood pressure (BP) elevation. The aim: to investigate the features of the heart rate variability (HRV), large vessel remodelling (VR) and metabolic parameters in subjects with stage 1 AH according to the new American guidelines (130–139 / or 80–89 mmHg). Design and method: We investigated 148 untreated subjects with the following BP levels (mmHg): < 120 / and < 80 (group 1; n = 33), 120–129 / and < 80 (group 2; n = 27), 130–139 / or 80–89 (group 3; n = 60), > = 140 / or > = 90 mmHg (group 4; n = 28). HRV indices were assessed by 24-hour Holter monitoring data, large vessel remodelling parameters - on the basis of applanation tonometry (Sphygmocor) and carotid echo-tracking (Artlab) data. The results are presented as mean ± standard deviation. Results: In comparison to group 1, group 2 had lower levels the high-density lipoproteins levels (61.7 ± 15.6 and 51.7 ± 11.6 mg/dl, respectively, p = 0.009), increased diameter of carotid artery (6.8 ± 0.4 and 7.5 ± 0.5 mm, respectively, p = 0.034) and similar pattern of HRV parameters. Group 3, compared to groups 1 and 2, had signifi cantly higher glucose and uric acid levels (p = 0.045 and p = 0.017, respectively), and also increased carotid-femoral pulse wave velocity, compared to groups 1 (7.8 ± 1.2 and 7.2 ± 0.9 m/s, respectively, p = 0.025). These alterations were associated with an increase in the high-frequency component of HRV (HF, p = 0.013 and r-MSSD, p = 0.022) and greater distensibility of the carotid vascular wall (p = 0.004), which were not observed in the group 4. Conclusions: Subjects with blood pressure of 130–139 / or 80–89 mmHg are characterized by distinct metabolic abnormalities, initial signs of vascular remodelling and alterations of HRV, which might predispose to further progression of BP elevation and development of target organ damage.