The significance of the effect of glycemic control on heart rate and blood pressure variability in patients with type 1 diabetes
Background. Сardiovascular diseases in diabetes mellitus remain the leading cause of death of these patients. The purpose was to determine changes in heart rate and blood pressure variability in patients with type 1 diabetes mellitus depending on the duration of the disease and the control of glycemia. Materials and methods. We examined 46 patients. The average age of them was 29.40 ± 3.18 years, duration of the disease — 12.50 ± 1.84 years, body mass index — 23.10 ± 0.73 kg/m2. All patients received insulin therapy on a standard bolus scheme, a daily dose of insulin was 45.00 ± 3.76 units. Patients were divided into 2 groups according to the level of glycated hemoglobin (HbA1c): group 1 (n = 20) with HbA1c ≤ 7.5 %, and group 2 (n = 26) with HbA1c > 7.5 %. The groups were divided into subgroups according to the absence (A) or the presence (B) of hypoglycemia. All patients underwent 24-hour Holter ECG monitoring and 24-hour ambulatory blood pressure monitoring in parallel with long-term monitoring of blood glucose. Results. It was found that in patients with type 1 diabetes mellitus, an increase in the disease duration is characterized by a significant decrease in heart rate variability, both hour and frequency indices, namely, a decrease in root mean square of the successive differences, pNN50, and an increase in low frequency/high frequency ratio. The variability of diurnal blood pressure is realized mainly due to an increase in daily diastolic blood pressure. The presence of episodes of hypoglycemia significantly affects both temporal and spectral heart rate variability indices, regardless of HbA1c level. Conclusions. Episodes of hypoglycemia are accompanied by an increase in systolic, diastolic blood pressure and in the heart rate. The incidence of hypoglycemic episodes increases with the duration of type 1 diabetes mellitus, regardless of the HbA1c level.
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