Comparative study of cardiac autonomic status by heart rate variability between under-treatment normotensive and hypertensive known type 2 diabetics

Abstract

Background: Co-existence of hypertension is known in three quarter of Indian type 2 diabetics, this duo having adverse additive effect on cardiovascular health including dysautonomia. Latter can be measured by simple 5 min heart rate variability (HRV) using simple electrocardiogram, which if reduced indicates cardiac risk. Objective: We compared HRV parameters between hypertensive and normotensive type 2 diabetics, looking for significant difference if any. Materials and methods: 98 hypertensive and 40 normotensive type 2 diabetics treated as outpatients were evaluated for disease control and risk stratification. Five min resting HRV was measured by Variowin HR, software based instrument, using standard protocols to record time domain, frequency domain and Poincare plot parameters. They were compared between groups for difference. Results: Mean age was 56 and 51 years, duration 6 years and 4 years respectively in hypertensive (HT) and normotensive (NT) group of type 2 diabetics, which did not significantly differ in distribution of risk factors. There was poor glycaemic control (one third) in both groups and good pressure control in HT group. Both groups revealed all reduced HRV parameters with significant difference in-between only for LF/HF ratio (1.29 in HT vs 2.61 in NT group). Conclusion: Our findings of HRV suggest that in type 2 diabetics with poor glycaemic and good pressure control, hypertension as a co-existing factor does not make significant difference in cardiac dysautonomia emphasizing residual risk despite antihypertensive treatment and need for early HRV screening, strict glycaemic control and other interventions.

Keywords

• Dysautonomia
• Heart rate variability
• Hypertension
• Normotensive
• Type 2 diabetes