Coronary heart disease and cardiovascular autonomic neuropathy in the elderly diabetic.

Diabetes and old age come together to increase the frequency and severity of coronary heart disease. Often clinically nearly silent, symptoms frequently manifest dramatically, to such an extent that the question of screening should be raised, as in younger subjects. Preventing these manifestations relies on better management of the cardiovascular risk factors and obtaining good blood glucose control, but here progress remains necessary, which also requires adapting to the older patient's clinical and psychological condition. Cardiovascular autonomic neuropathy is a frequent degenerative complication in diabetics, particularly in the oldest subjects. The most severe types have serious clinical consequences, thus a higher mortality factor, but the mechanisms remain poorly understood. As for coronary heart disease, the therapeutic tools have expanded these last few years and should be thought out in relation to the geriatric evaluation, with the objective of improving these patients' quality of life. Therefore, a necessary distinction should be made between subjects who have aged successfully, whose management, ultimately, differs little from younger subjects, and frail elderly individuals for whom exploratory techniques and treatment should be adapted.

Use of runs test to assess cardiovascular autonomic function in diabetic subjects.

OBJECTIVE: We suggest a simple, noninvasive method to assess the autonomic function in diabetic subjects. The method requires only a monitoring of heart rate (HR) with subjects in the sitting position. RESEARCH DESIGN AND METHODS: Sixty diabetic subjects, 44 men and 16 women, between 20-80 years of age, were recruited, chronologically, for this study. Subjects treated for high blood pressure were not included. Their autonomic function was assessed by the total score of five classical cardiovascular function tests. In the same subjects and in 44 healthy subjects, blood pressure and HR were determined from beat to beat by the Finapres system with subjects in the sitting position. We examined the randomness of the HR changes by calculating the zeta statistic of the runs test on 1,000 successive HR readings (the zeta value is low if the HR changes are random). When the HR changes are random, we consider that the autonomic control of HR is impaired. RESULTS: The zeta values of HR changes were significantly lower in diabetic subjects compared with normal subjects (2.98 +/- 0.97 vs. 3.54 +/- 0.97, P < 0.004). In diabetic subjects, the zeta value was closely correlated to the total score of disautonomy (r = -0.66, P < 0.0001, after correction for age effect) and to the office systolic blood pressure (r = -0.43, P < 0.001). CONCLUSIONS: The zeta value of HR changes might be a marker of the autonomic function in diabetic subjects.

Inverse relationship between upright plasma renin activity and twenty-four hour blood pressure variability in borderline hypertension.

Office, i.e. measured by the physician at rest, and 24 h ambulatory systolic (SBP) and diastolic (DBP) blood pressures, heart rate, supine and upright plasma renin activities, supine and upright aldosterone concentrations and plasma and urine sodium and potassium were measured in 61 young male subjects aged 19-25 years, including 40 normotensive subjects (office DBP less than or equal to 90 mmHg and office SBP less than or equal to 140 mmHg) and 21 borderline hypertensive subjects (non-normal blood pressures with office DBP less than or equal to 95 mmHg and office SBP less than or equal to 160 mmHg). No significant differences were found in the plasma or urine K+ or Na+, upright or supine plasma renin activity or aldosterone concentration between normotensives and borderline hypertensive subjects. No correlation was detected between plasma and urine K+ or Na+, upright and supine aldosterone concentration or supine plasma renin activity and blood pressure. In contrast, significant inverse correlations were observed between upright plasma renin activity and blood pressure. The correlations were approaching statistical significance when upright plasma renin activity was related to office SBP and office DBP (r = -0.22, P = 0.097 and r = -0.25, P = 0.049, respectively), and were more significant when plasma renin activity was related to 24 h mean DBP (r = -0.32, P = 0.013) and to SBP and DBP standard deviations (r = -0.37, P = 0.004 and r = -0.26, P = 0.04, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Short-term representatives of daytime and night-time ambulatory blood pressures.

OBJECTIVE: To see whether measurements of ambulatory blood pressure during short-term daytime and night-time periods can represent complete daytime and night-time pressures accurately. DESIGN: Short-term measurements would be less uncomfortable for patients, easier to perform and could lead to fewer missing values, outliers or artefacts than full-day measurements, especially when repeated monitorings are required. METHOD: Ambulatory blood pressure was measured every 15 min for 24 h in 254 subjects with normal or borderline office blood pressure. Each pressure profile included at least 80 valid readings. Mean blood pressures for different 1-, 2-, 3-, 4-, 5- and 6-h spans were calculated and compared with mean daytime and night-time values using paired Student's t-test. RESULTS: One or two-hour spans of daytime blood pressure poorly represented mean daytime pressure. In contrast, 4-h readings, selected between 1000-2200 h represented daytime blood pressure with good accuracy. Over the total sample, 4-h mean blood pressure readings from 1000-2200 h differed from daytime readings by less than 2 mmHg and 2-h mean readings from 0300-0700 h differed from mean night-time readings by less than 1 mmHg. CONCLUSION: We suggest that 4-h measurements of ambulatory blood pressure during the daytime and 2-h measurements at night (with time spans selected as indicated as above) may be of value.

Active ambulatory blood pressures and urinary electrolytes in young male subjects with normal blood pressure or borderline hypertension.

OBJECTIVES: To examine the relationship between ambulatory blood pressure (ABP) and 24-h urinary electrolytes in young subjects with normal blood pressure or borderline hypertension. DESIGN: ABP shows a circadian profile. We question whether high- and low-level pressure spans might have a relationship with urinary salt output. METHODS: ABP was monitored by the SpaceLabs 5200 system in 182 young male subjects (aged 17-25 years) with normal or borderline office blood pressure. In all subjects, 24-h urinary sodium, potassium and chloride were measured. The mean values and SD of ABP during 24 h, or during the daytime (0900-2100 h) and night-time (2115-0845 h), were estimated. In addition, using a 'cumulative sum' method, 'active' (high-level) and 'passive' (low-level) spans of APB were identified in each subject. RESULTS: No relationship was found between 24-h urinary sodium, potassium or chloride and office systolic blood pressure. Also, no relationship was found between the electrolytes and mean value or SD of ABP during 24 h, daytime or night-time. In contrast, significant positive correlations were found between 24-h urinary sodium and active systolic and diastolic blood pressure. The present study suggests that the active blood pressure span is associated with salt intake in normal and borderline blood pressure groups.

Ambulatory blood pressure monitoring: a critical review of the current methods to handle outliers.

OBJECTIVES: To examine the methods to handle marginal readings in the analysis of ambulatory blood pressure. DESIGN: Data obtained from automatic ambulatory blood pressure monitoring include several 'outliers', i.e. readings at the frontier of physiologically acceptable ranges. Several methods have been used to handle these readings. We need to know whether using different methods to reject outliers leads to different results in the analysis of the data. If so, then it is important that a common method be used by different authors. METHODS: Ten reported methods to handle outliers were selected and applied to a large set of unpublished blood pressure profiles (Novacor Diasys system). We compared the effects of data rejection by these methods on the mean values and standard deviations (calculated over 24 h, daytime and night-time) of the remaining data. RESULTS: The different methods had quite different effects on the same data set. Depending on the method used, the discarded data varied from 1 to 17% of the total number of readings. Among the rejected data, readings that occurred in the daytime varied from 14 to 56%. Also, 'high-value' outliers varied from 1 to 60% of the rejected data. On average over the total sample, the rejection of outliers had only a small effect on the mean values of blood pressure. In contrast, it may strongly reduce the standard deviation of the readings. CONCLUSION: The study emphasized the need to use a common method to handle outliers in the analysis of ambulatory blood pressure data.

Ambulatory blood pressure in diabetic subjects.

Ambulatory blood pressure (ABP) was measured every 15 min for 24 h in 82 diabetic subjects aged 35 to 79 years and in 66 healthy controls having the same age and office blood pressure. The autonomic control in diabetic subjects was evaluated by the total score of five cardiovascular function tests (a high score means an autonomic neuropathy). The diurnal cycle of BP was assessed by the difference of BP between daytime and nighttime (delta BP = BP in the day - BP in the night). The variability of BP was evaluated by the standard deviations of the readings. Compared with control subjects, diabetic subjects had the same 24-h mean level of BP, a smaller delta BP, and an increased variability during the daytime; however, the differences were in the limit of statistical significance. Clearcut results were obtained in diabetic subjects with autonomic neuropathy. In the latter, the score of autonomic neuropathy was (1) negatively correlated to delta SBP (systolic) and delta DBP (diastolic) (r = 0.44, P = .0004 and r = 0.46, P = .0004, respectively) and (2) positively correlated to the variability of SBP and DBP during the daytime (r = 0.46, P .0004 and r = 0.29, P = .03, respectively). In diabetic subjects, mean level and variability of ABP were positively correlated to urinary microalbumin. The relationships were the most significant when one relates microalbuminuria to the level of SBP in the night (r = 0.42, P < .0003) and to the variability of SBP in the day (r = 0.32, P = .008).(ABSTRACT TRUNCATED AT 250 WORDS)

Ambulatory monitoring of blood pressure in normal pregnancy.

The definition of hypertensive disorders in pregnancy is plagued by many difficulties, in part related to the limits of intermittent clinic readings of blood pressure. In order to better define the evolution of arterial blood pressure in normal subjects during normal pregnancy, casual and ambulatory (Spacelabs 90207, n = 22 or Diasys 200, n = 26) measurements of blood pressure were performed at gestational months 3, 6, and 9, in 48 normal women aged 18 to 39, both nulliparas (n = 19) and multiparas (n = 29). Ambulatory blood pressure levels were lowest in the first gestational trimester (24-hour mean: 104 +/- 8/63 +/- 6 mm Hg) and rose by a small increment during the last trimester (109 +/- 8/67 +/- 7 mm Hg at 8 months). Mean daytime ambulatory pressure was almost superimposable to clinic measurements at the three time points. A day-night variation in blood pressure level was detectable in all subjects at each recording. It is concluded that during normal pregnancy, ambulatory blood pressure levels were highest in the day and lowest at night at all gestational ages and increased only minimally before the ninth month. Reference values, as defined by the percentile distribution of daytime and nighttime systolic and diastolic blood pressure, may help define more precisely an alteration in the level and/or the circadian variation of arterial blood pressure during abnormal pregnancies.

Home blood pressure monitoring in diabetic population.

Normalization of blood pressure is today as necessary as an optimal blood glucose control. These targets aim at reducing the negative consequences of hypertension which is particularly frequent and of poor prognosis for these patients. Nevertheless, the definition of the real blood pressure of these patients is uneasy because of the lack of precision of clinical blood pressure measurement. New methods have been developed to address this insufficiency. Home blood pressure monitoring is characterised by good compliance and accuracy, but patient education needs a special training and validated automated devices. This method has to be proposed to the diabetic population as soon as hypertension may be a problem. These patients will contribute to monitor their own blood pressure as they do it with blood glucose control.

User procedure for self-measurement of blood pressure. First International Consensus Conference on Self Blood Pressure Measurement.

OBJECTIVE: To review the medical literature regarding the methodology of self-measurement of blood pressure and to provide some practical recommendations regarding protocol and procedure for measurement, documentation and analysis of data, choice and provision of devices and education of patients and physicians. PROCEDURE AND PROTOCOL FOR MEASUREMENTS: Technical recommendations regarding measurement of blood pressure do not differ from usual guidelines. Frequency of measurement remains a matter of discussion. At the beginning of the self-measurements of blood pressure and during the titration phase, there should be a 7-day measurement period with two measurement of blood pressure each morning and two measurements in the evening at pre-stipulated times. For long-term observation, a minimum measurement period of 1 week per quarter is required. The minimum number of measurements performed during each period should be a total of 12 readings recorded within seven working days. Depending on individual needs (e.g. poor compliance) or for pharmacologic studies, a higher frequency of readings could be used. DOCUMENTATION AND ANALYSIS OF DATA: Owing to the lack of reliability of patients' diaries, the use of printer-equipped or memory-equipped devices is advocated. All the recorded data, except those obtained on the first day, must be used for analysis. CHOICE AND PROVISION OF DEVICES: Self-measurement of blood pressure should be performed with validated fully automated devices using a brachial cuff. The preference should be given to apparatus offering the possibility of storing and transmitting measurements. Wrist apparatus should be used with caution due to the risk of measurement errors if it is used inappropriately. A manual device should be considered for patients suffering from irregular cardiac rhythms and patients with large or small arm circumferences, since automated devices have not been validated for use in these situations. Reimbursement of hypertensive patients using validated devices should be considered, so long as they are adequately trained and supervised. EDUCATION OF PATIENTS: In a therapeutic perspective, self-measurement of blood pressure should be performed by trained patients under the supervision of their practitioner. Teaching must be performed by skilled staff in hypertension centers and ultimately in general practice. Self-measurement of blood pressure is to be recommended for any hypertensive patient who is sufficiently motivated to participate in the treatment of his own hypertension. Patients with physical problems or mental disabilities that make them unable to perform or to understand the measuring technique represent the limits of the method. Education of patients must encompass information about hypertension and cardiovascular risk, blood-pressure-measurement procedures, advice on items of equipment and their proper use, protocols, and interpretation of data. A patient's proficiency must be checked before he or she should be considered competent at performing the procedure. Annual reevaluation is required.

[Leiomyosarcoma of the right ventricle]. / Léiomyosarcome cardiaque du ventricule droit.

A 58-year-old woman has dyspnea and palpitations which reveal a leiomyosarcoma of the right ventricle. The medical imaging shows a lobulated sessile tumor attached to the ventricular septum and the tricuspid valve extending into the pulmonary artery trunk. The resection is performed with a tricuspid valvoplasty. In spite of chemotherapy (epirubicin-cyclophosphamide), relapse is observed with pulmonary metastases 17 months after the surgery. The death becomes on 18 months in congestive heart failure. From this case, the authors make a review of the literature about this exceptional tumour, and talk over the low possibilities of treatment, despite the capacities of the new ways of diagnosis.

[Normal and borderline ambulatory arterial pressures. A new method for establishing reference values]. / Pressions artérielles ambulatoires normale et limite. Une nouvelle méthode pour établir les valeurs de référence.

Ambulatory arterial pressures, both systolic (SAP) and diastolic (DAP), together with heart rate were measured every 15 minutes during 24 hours, using a Spacelabs 5200 apparatus, in 168 male subjects of mean age 21 +/- 1 years. According to the WHO criteria, 72 subjects had normal arterial pressure (clinical DAP less than or equal to 90 mmHg, clinical SAP less than or equal to 140 mmHg), and 86 subjects had untreated borderline arterial hypertension (abnormal clinical pressures, with clinical DAP less than or equal to 95 mmHg and clinical SAP less than or equal to 160 mmHg). On the basis of the WHO criteria, a sizeable part of pressure profiles in the normal and hypertensive groups overlapped. The Mc Queen method, derived from cluster analysis, considerably reduces this overlap. The method defines and objective criterion which enables the subjects to be reclassified in cases where clinical and ambulatory pressures "contradict each other". Such reclassification applied in about 20% of our subjects. This leads to a new definition of reference groups based on both clinical pressure and ambulatory pressure profile. The WHO criteria remain the basis for this classification. The Mc Queen method may be used to define normal and borderline arterial pressure profiles in male and female subjects of different age-groups.

[Circadian variations of blood pressure]. / Variations circadiennes de la pression artérielle.

Blood pressure (BP) exhibit diurnal variations with low level during night time and high level during daytime. There is little evidence of an endogenous mechanism of BP variations whereas a lot of clues show the contribution of external factors such as activity, mood, postures. Different pathophysiological conditions may alter the pattern of BP circadian variations. This is the case of severe hypertension, hypertension in the elderly and some secondary forms of the disease. Other pathological conditions concerned by BP rhythm alterations are dysautonomia, complicated diabetes, Cushing syndrome, organ transplantations. Methods currently in use to handle data are reviewed.

[Evaluation of borderline arterial hypertension in young adults by ambulatory arterial pressure measurements]. / Evaluation de l'hypertension artérielle limite de l'adulte jeune par mesure ambulatoire de la pression artérielle.

Casual measurements of blood pressure (BP) with a mercury manometer and ambulatory BP recordings with the Spacelabs apparatus at the rate of one measurement every 15 minutes during 24 hours were carried out in two groups of young male adults of the same age. One group consisted of 105 normotensive controls (age 21.2 +/- 1.5 years, weight 69 +/- 8 kg, height 177 +/- 8 cm, casual BP 129/75 mmHg). The other group comprised 104 subjects with borderline hypertension (BHT) as defined by the WHO criteria (age 21.2 +/- 1.6 years, weight 74 +/- 12 kg, height 177 +/- 7 cm, casual BP 148/83 mmHg). Mean levels of recorded BP in controls were: 24 hours 122/70 mmHg, active periods (9 a.m. to 8.30 p.m.) 128/74 mmHg, night 111/64 mmHg. The corresponding values in BHT subjects were: 24 hours 132/83 mmHg, active periods 137/79 mmHg, night 118/67 mmHg. There was no difference between mean casual BP measurements and mean BP recordings during periods of activity in controls, whereas BP recordings during periods of activity were lower in BHT subjects. Results of the two measurement methods showed important individual variations. BP variability (variation coefficient = VC) in BHT subjects was more pronounced in respect of systolic arterial pressure than in controls: Syst VC 24 h: Contr. 12 p. 100, BHT 13 p. 100, p less than 0.001; Diast VC 24 h: Contr. 17 p. 100, BHT 18 p. 100, p less than 0.05. In both populations there was no difference in VC between night and day.(ABSTRACT TRUNCATED AT 250 WORDS)

[Is placebo necessary in a clinical trial on ambulatory blood pressure?]. / Le placebo est-il nécessaire dans un essai clinique sur la pression artérielle ambulatoire?

Placebo has only a slight effect on ambulatory blood pressure (ABP). Some authors have suggested that the use of a placebo is not necessary in a study on the drugs effect on ABP. We demonstrate that even if placebo effect is small, the use of a placebo group is still necessary. Effects of one daily dose of 50 mg atenolol + 20 mg slow-released nifedipine (AN) were investigated. Patients with office DBP 90-110 mmHg received, in a double-blind protocol, either AN (group AN, n = 31) or a placebo (group P, n = 26). Ambulatory BP (ABP) and HR were measured (Spacelabs or Diasys systems) for 24 h before and one month after treatment. The 2 groups were comparable before treatment. After 1 month under treatment, ABP was significantly lower in the AN group, compared to the P group, and this over the whole day (p = 0.03 to p < 0.0001). The effect was the most important between 10-17 h (p < 0.0001). HR was significantly lower in the AN group during daytime (6-22 h), but not during the night (22-6 h). Over the whole group, placebo effect was not significant. However, ABP did decrease under placebo in subjects with high initial pressure. As a result, an analysis without data from the placebo group led to an overestimation of the effects of the drug.

[Computerized processing, using a Macintosh, of ambulatory arterial pressure measurements collected on a Spacelabs monitor]. / Traitement informatisé sur Macintosh des mesures de pression artérielle ambulatoires recueillies sur moniteur Spacelabs.

UNLABELLED: The use of the Spacelabs blood pressure recorder has given rise to processing programs running on Apple II and IBM PC computers. The authors have written in M.S. BASIC (2.1) a program who take advantage of graphic abilities and easy manipulation on Macintosh. The software was designed to perform three tasks: Communicating between Macintosh and Spacelabs station using serial interface (RS 232) without requesting specific interface card. Editing a report on two pages: The first is the listing of 96 measurements (one by 15 minutes). The second provides: patient identification, height, weight, diagnosis. Graphic representation of measurements Systolic and diastolic blood pressure (BP) repartition histogram for 24 hours, day and night. Standard deviation and mean of pressure and heart rate (HR) for those periods. A third optionally gives hourly chronogram and diagrams for cumulated BP and HR. Creating a file: 550 records can be stored on a 800 K floppy disk. The file handles: data for each patient (excepted identification). Random access and revision of each parameter is possible. SYNTHESIS: comparative reports for group patients and patient by patient analysing data with appropriate statistical test (ANOVA and correlation) are done.

[Comparative evaluation of diabetic cardiac autonomic neuropathy by spectrum analysis and Ewing's tests]. / Evaluation comparative de la neuropathie végétative cardiaque diabétique par analyse spectrale et tests d'Ewing.

METHODS: 62 diabetic patients of both sex (age: 46 +/- 16 yr, BMI: 26.1 +/- 4 kg/m2, casual blood pressure: 134 +/- 17/81 +/- 11 mmHg, mean age of diabetes: 11 +/- 9 yr) without cardiovascular medications were recruited. Autonomic involvement was based on the results from a battery of five cardiovascular tests as suggested by Ewing. The result of each test and a scoring system was considered. All patients underwent power spectral analysis (PSA) of digital blood pressure (BP) and RR intervals recorded in the recumbent position and after tilting with a Finapres monitor. The percentage of total power (0.025-0.4 Hz) computed in the low-frequency band (0.070-0.139 Hz) computed in the low-frequency band (0.070-0.139 Hz) was chosen as a sympathetic index (sigma Ind). Results of tests were correlated with sigma Ind. RESULTS: 24 patients (39%) have an autonomic involvement. The most affected tests are: the Valsalva maneuver (VAL): 16% RR response from lying to standing (LS): 25%, sustained handgrip (SHG): 30%, postural hypotension (PH); 57%, deep breathing (DB): 87%. Correlations coefficients of cardiovascular tests and sigma Ind are: VAL/sigma Ind (SBP tilt): r = 0.277, p = 0.029; Val/sigma Ind (DBP tilt): r = 0.318, p = 0.012; VAL/sigma Ind (RR tilt): ns. PH/Ind sigma (SBP tilt): r = 0.391, p = 0.0017; PH/sigma Ind (DBP tilt): r = -0.296, p = 0.019; PH/sigma Ind (RR tilt): r = -0.308, p = 0.015, DB/sigma Ind (SBP tilt): r = 0.417, p = 0.0007; DB/sigma Ind (DBP tilt): r = 0.361, p = 0.0039; DB/sigma Ind (RR tilt): ns. Results of LS and SHG show no correlation with Ind sigma. Correlations between global autonomic score (GAS) and sigma Ind during tilting have the following values: GAS/sigma Ind (SBP tilt): r = -0486, p = 0.0001; GAS/sigma Ind (DBP tilt): r = -0.385, p = 0.002; GAS/sigma Ind (RR tilt): r = -0.411, p = 0.0009. CONCLUSIONS: The so-called sympathetic index computed from PSA are well correlated with autonomic tests. They allow an early detection of sympathetic involvement in diabetics patients. These results are to consider while managing these subjects.

[Increased vasodilation response to the stimulation of low pressure mechanoreceptors in borderline hypertension]. / Augmentation de la réponse vasodilatatrice à la stimulation des mécanorécepteurs à basse pression chez l'hypertendu limite.

Passive lifting of the lower limbs (antitilt) is a simple manoeuvre which stimulates low-pressure mechanoreceptors. Patients with borderline hypertension have an alteration of the arterial baroreflex modulated by an increased inhibitory effect of cardiopulmonary mechanoreceptors on vasomotor centres. The repercussions of antitilt on mean arterial pressure (MAP), heart rate (HR) and blood flow rate in the forearm (FRFA) were studied in 30 male subjects aged 18 to 25 years: 14 with untreated borderline hypertension ("patients") and 16 controls. FRFA was measured with a plethysmograph by means of a mercury constraint gauge. MAP was recorded during exploration with a DINAMAP instrument. The parameters were measured in recumbent position, then within minutes of the antitilt manoeuvre. In recumbent position the differences between patients and controls were: MAP 94.7 +/- 6 vs 84.7 +/- 7 mmHg (p less than 0.001); HR 76 +/- 13 vs 63 +/- 9 beats/min (p less than 0.01); FRFA 4.6 +/- 1.5 vs 3.5 +/- 1.4 ml/min/100 ml (p less than 0.05). Following antitilt, MAP and HR remained unchanged in the two groups, but there was a significant increase of FRFA in both controls (+ 0.6 +/- 0.2 ml/min/100 ml; p less than 0.02) and patients (+ 1.3 +/- 0.2 ml/min/100 ml; p less than 0.001). This increase was significantly greater in patients than in controls (p less than 0.05). This study shows that antitilt produces an increase of blood flow rate in the forearm that is more pronounced in patients with borderline hypertension than in controls. The stability of MAP and HR is in favour of non-actuation of the high-pressure arterial baroreflex.(ABSTRACT TRUNCATED AT 250 WORDS)

[Vegetative neuropathy and pressure regulation in diabetics]. / Neuropathie végétative et régulation tensionnelle chez le diabétique.

UNLABELLED: The present study was undertaken to evaluate the effects of autonomic cardiovascular neuropathy (ACN) on blood pressure control in diabetic patients. METHODS: a nyctohemeral blood pressure (BP) monitoring (Spacelabs 5200) and an assessment of ACN, graded with a scoring system depending on usual test (Valsalva maneuver, heart response to deep breathing, blood pressure response to standing up and sustained handgrip) were performed in 90 normotensive male subjects. Thirty controls, age: 49 +/- 13 years, weight: 72 +/- 12 kg, height: 174 +/- 6 cm and 60 diabetic patients, type 1 or 2, age: 52 +/- 13 years, weight: 75 +/- 12 kg, height: 174 +/- 6 cm were recruited. RESULTS: mean BP levels recorded on 24 hours (control: 117 +/- 13/75 +/- 9 mmHg, diabetic: 119 +/- 12/74 +/- 7 mmHg), BP variability measured with the coefficient of variation (SD/mean) (control: syst = 13 +/- 4, diast = 15 +/- 4; diabetic: syst = 12 +/- 3, diast = 14 +/- 4), differences between mean BP on day-time (9 a.m. - 8:30 p.m.) and mean BP on night-time (10:30 p.m. - 7:30 a.m.) (control: syst = 16 +/- 10 mmHg, diast = 11 +/- 8 mmHg; diabetic: syst = 13 +/- 10 mmHg, diast = 10 +/- 7 mmHg) are not statistically different. It is the same with heart rate. Two control and 11 diabetic subjects have impaired ACN tests. Among diabetic subjects, impairment of autonomic nervous cardiovascular system is correlated with abnormal BP pattern (loss of nocturnal fall, paradoxical nocturnal rise seen in 15 patients).(ABSTRACT TRUNCATED AT 250 WORDS)

[Chaotic aspect of heart rate and blood pressure in diabetic patients]. / Aspect chaotique de la fréquence cardiaque et de la pression artérielle chez le sujet diabétique.

We applied a simplified version of the method suggested by Sugihara-May (Nature 1990: 344: 734-41) to study the control of heart rate (HR) in subjects with diabetes mellitus. The method aims to predict the future of an observation, if a series of observations on the same phenomenon is available. The method quantifies the fact that the series is predictable more or less longtime in the future. A random series is only shortly predictable in the future. HR and blood pressure were measured from beat to beat (by the Finapres system) for about 0.5 hours in 11 subjects with diabetes mellitus and normal blood pressure (group D) and in 10 controls subjects (group N). The subjects were sitting in a temperature-controlled quiet room, isolated from all external stimuli. The 2 groups were matched for age, and had the same weight and height. No difference was observed in mean-value and standard deviation (SD) of BP and HR between the 2 groups. Groups N/D: SBP = 112 +/- 11/123 +/- 11 mmHg, NS; DBP = 64 +/- 9/67 +/- 12 mmHg, NS; HR = 70 +/- 10/69 +/- 7 b/min, NS. Standard deviation of PAS = 5.5 +/- 1.6/5.7 +/- 1.9 mmHg, NS and SD of DBP = 3.5 +/- 0.9/3.4 +/- 1.2 mmHg, NS. The SD of HR (3.0 +/- 0.5/2.3 +/- 1.0 b/min in groups N/D) was somewhat lower in diabetics than in control subjects but the difference was not significant.(ABSTRACT TRUNCATED AT 250 WORDS)