The analysis of a reference value for baroreflex sensitivity and cardiovascular autonomic neuropathy prevalence in a Chinese population

Zi-Hui Tang, Fangfang Zeng, Kuangping Ye, Xiaoling Yu, Linuo Zhou, Zi-Hui Tang, Fangfang Zeng, Kuangping Ye, Xiaoling Yu, Linuo Zhou

Abstract

Background: Cardiovascular autonomic neuropathy (CAN) is rapidly growing in all populations worldwide. Baroreflex sensitivity (BRS) is easily applied as a diagnostic test to a large number of individuals in the general population. However, no study has reported the normal reference values of BRS for the CAN diagnostic test in a Chinese population. The aim of this study was to estimate the normative reference value of BRS, and assess CAN prevalence in our cross-sectional dataset.

Methods: We conducted a large-scale, community-based, cross-sectional study in a Chinese population. We performed data analysis on 2,092 subjects. Cardiovascular autonomic function was assessed using spontaneous BRS. A total of 349 healthy subjects were used to perform analysis for the reference value for BRS. The CAN prevalence was calculated in the overall sample, and in patients with diabetes mellitus, patients with hypertension and patients with metabolic syndrome.

Results: In the overall sample, the reference value for total power (TP.brs) was more than 1.96 ms/mmHg. The cut-off points of 1.74 ms/mmHg and 2.53 ms/mmHg were set as high frequency (HF.brs) and low frequency (LF.brs), respectively. CAN diagnostic tests based on the reference value were performed. The estimated CAN prevalence in the overall sample was 20.41% using the BRS test. CAN prevalence was 33.18%, 28.69% and 28.57% in patients with diabetes mellitus, patients with hypertension and patients with metabolic syndrome, respectively.

Conclusions: Our findings provided reference values for BRS. Estimated CAN prevalence was high in this Chinese population, which has become a major public health problem in China.

Figures

Figure 1
Figure 1
Results of correlation analysis between age and parameters of baroreflex sensitivity. Correlation analysis between (A) age and total power (TP.brs; r = −0.104, P =0.054), (B) age and high frequency (HF.brs; r = −0.001, P =0.994) and (C) age and low frequency (LF.brs; r = −0.095, P =0.086).

References

    1. Hazari MA, Khan RT, Reddy BR, Hassan MA. Cardiovascular autonomic dysfunction in type 2 diabetes mellitus and essential hypertension in a South Indian population. Neurosciences (Riyadh) 2012;17:173–175.
    1. Spallone V, Ziegler D, Freeman R, Bernardi L, Frontoni S, Pop-Busui R, Stevens M, Kempler P, Hilsted J, Tesfaye S. Cardiovascular autonomic neuropathy in diabetes: clinical impact, assessment, diagnosis, and management. Diabetes Metab Res Rev. 2011. [Epub ahead of print]
    1. Garruti G, Giampetruzzi F, Vita MG, Pellegrini F, Lagioia P, Stefanelli G, Bellomo-Damato A, Giorgino F. Links between metabolic syndrome and cardiovascular autonomic dysfunction. Exp Diabetes Res. 2012;2012:615835.
    1. Iodice V, Low DA, Vichayanrat E, Mathias CJ. Cardiovascular autonomic dysfunction in MSA and Parkinson's disease: similarities and differences. J Neurol Sci. 2011;310:133–138. doi: 10.1016/j.jns.2011.07.014.
    1. Ding W, Zhou L, Bao Y, Yang Y, Lu B, Wu X, Hu R. Autonomic nervous function and baroreflex sensitivity in hypertensive diabetic patients. Acta Cardiol. 2011;66:465–470.
    1. Pop-Busui R. Cardiac autonomic neuropathy in diabetes: a clinical perspective. Diabetes Care. 2010;33:434–441. doi: 10.2337/dc09-1294.
    1. Vinik AI, Ziegler D. Diabetic cardiovascular autonomic neuropathy. Circulation. 2007;115:387–397. doi: 10.1161/CIRCULATIONAHA.106.634949.
    1. Li Z, Tang ZH, Zeng F, Zhou L. Associations between the severity of metabolic syndrome and cardiovascular autonomic function in a Chinese population. J Endocrinol Invest. 2013 Dec;36(11):993–999.
    1. Grundy SM, Hansen B, Smith SC Jr, Cleeman JI, Kahn RA. Clinical management of metabolic syndrome: report of the American Heart Association/National Heart, Lung, and Blood Institute/American Diabetes Association conference on scientific issues related to management. Circulation. 2004;109:551–556. doi: 10.1161/01.CIR.0000112379.88385.67.
    1. Bian RW, Lou QL, Gu LB, Kong AP, So WY, Ko GT, Ouyang XJ, Mo YZ, Ma RC, Chan JC, Chow CC. Delayed gastric emptying is related to cardiovascular autonomic neuropathy in Chinese patients with type 2 diabetes. Acta Gastroenterol Belg. 2011;74:28–33.
    1. Gerritsen J, TenVoorde BJ, Dekker JM, Kingma R, Kostense PJ, Bouter LM, Heethaar RM. Measures of cardiovascular autonomic nervous function: agreement, reproducibility, and reference values in middle age and elderly subjects. Diabetologia. 2003;46:330–338.
    1. Tank J, Neuke A, Molle A, Jordan J, Weck M. Spontaneous baroreflex sensitivity and heart rate variability are not superior to classic autonomic testing in older patients with type 2 diabetes. Am J Med Sci. 2001;322:24–30. doi: 10.1097/00000441-200107000-00005.
    1. Krontoradova K, Honzikova N, Fiser B, Novakova Z, Zavodna E, Hrstkova H, Honzik P. Overweight and decreased baroreflex sensitivity as independent risk factors for hypertension in children, adolescents, and young adults. Physiol Res. 2008;57:385–391.
    1. Lord SW, Clayton RH, Hall MC, Gray JC, Murray A, McComb JM, Kenny RA. Reproducibility of three different methods of measuring baroreflex sensitivity in normal subjects. Clin Sci (Lond) 1998;95:575–581.
    1. Hagglund H, Uusitalo A, Peltonen JE, Koponen AS, Aho J, Tiinanen S, Seppanen T, Tulppo M, Tikkanen HO. Cardiovascular autonomic nervous system function and aerobic capacity in type 1 diabetes. Front Physiol. 2012;3:356.
    1. Halliwill JR, Morgan BJ, Charkoudian N. Peripheral chemoreflex and baroreflex interactions in cardiovascular regulation in humans. J Physiol. 2003;552:295–302. doi: 10.1113/jphysiol.2003.050708.
    1. Rassaf T, Westenfeld R, Balzer J, Lauer T, Merx M, Floege J, Steiner S, Heiss C, Kelm M, Meyer C. Modulation of peripheral chemoreflex by neurohumoral adaptations after kidney transplantation. Eur J Med Res. 2010;15(Suppl 2):83–87.
    1. Tang ZH, Zeng F, Yu X, Zhou L. Bayesian estimation of cardiovascular autonomic neuropathy diagnostic test based on baroreflex sensitivity in the absence of a gold standard. Int J Cardiol. 2014 Feb 15;171(3):e78–e80. doi: 10.1016/j.ijcard.2013.11.100.
    1. Laitinen T, Lindstrom J, Eriksson J, Ilanne-Parikka P, Aunola S, Keinanen-Kiukaanniemi S, Tuomilehto J, Uusitupa M. Cardiovascular autonomic dysfunction is associated with central obesity in persons with impaired glucose tolerance. Diabet Med. 2011;28:699–704. doi: 10.1111/j.1464-5491.2011.03278.x.

Source: PubMed

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