Impact of Type 2 Diabetes Mellitus on Sympathetic Neural Mechanisms in Hypertension
Abstract
Background— Essential hypertension (EHT) is a major cardiovascular risk factor, and the additional presence of type 2 diabetes mellitus (DM2) increases this risk. However, although the sympathetic nerve hyperactivity of EHT is known to play a role in cardiovascular risk, the level of sympathetic nerve activity is known neither in DM2 nor in hypertensive type 2 diabetic patients (EHT+DM2). Therefore, we planned to quantify the vasoconstrictor sympathetic nerve activity in patients with EHT+DM2 and with DM2 relative to that in matched groups with EHT and normal blood pressure (NT). Methods and Results— In 68 closely matched subjects with EHT+DM2 (n=17), DM2 (n=17), EHT (n=17), and NT (n=17), we measured resting muscle sympathetic nerve activity as the mean frequency of multiunit bursts (MSNA) and of single units (s-MSNA) with defined vasoconstrictor properties. The s-MSNA in EHT+DM2 (97±3.8 impulses/100 beats) was greater (at least P <0.001) than in EHT (69±3.4 impulses/100 beats) and DM2 (78±4.1 impulses/100 beats), and all these were significantly greater (at least P <0.01) than in NT (53±3.3 impulses/100 beats) despite similar age and body mass index. The MSNA followed a similar trend. In addition, the level of insulin was also raised in EHT+DM2 (20.4±3.6 μU/mL) and DM2 (18.1±3.1 μU/mL; at least P <0.05) compared with HT or NT. Conclusions— Patients with EHT+DM2, EHT, or DM2 had central sympathetic hyperactivity, although plasma insulin levels were raised only in EHT+DM2 and DM2. The combination of EHT and DM2 resulted in the greatest sympathetic hyperactivity and level of plasma insulin, and this hyperactivity could constitute a mechanism for the increased risks of this condition.
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Only vasoconstrictor discharge was accepted after showing appropriate responses to spontaneous arterial pressure changes, the Valsalva maneuver, isometric handgrip exercise, and cold pressor tests.
“Only vasoconstrictor discharge was accepted after showing appropriate responses to spontaneous arterial pressure changes, the Valsalva maneuver, isometric handgrip exercise, and cold pressor tests.4,7,19,20”
From Sympathetic Neural Activation in Nondiabetic Metabolic Syndrome and Its Further Augmentation by Hypertension (2004) · cites this paper as [7]
In all subjects, measured variables were obtained in an identical manner as previously published.
“In all subjects, the measured variables were obtained in an identical manner as has been published previously.4,7”
From Sympathetic Neural Activation in Nondiabetic Metabolic Syndrome and Its Further Augmentation by Hypertension (2004) · cites this paper as [7]
Sympathetic activity indices showed a significant correlation to age in each of the four groups.
“Sympathetic activity indices showed a significant correlation to age in each of the 4 groups (r between 0.5 and 0.70; at least PϽ0.02) as has previously been reported.4,7”
From Sympathetic Neural Activation in Nondiabetic Metabolic Syndrome and Its Further Augmentation by Hypertension (2004) · cites this paper as [7]
Baroreceptor reflex sensitivity was lower in the hypertensive groups (EHT and MS+EHT) than in the normotensive groups (NC and MS-EHT); specifically, MS+EHT was similar to EHT, and both were less than MS-EHT and NC.
“The EHT groups had lower baroreceptor reflex sensitivity than the other 2 groups as previously reported.4,7”
From Sympathetic Neural Activation in Nondiabetic Metabolic Syndrome and Its Further Augmentation by Hypertension (2004) · cites this paper as [7]
The present study was designed to avoid traditional confounding factors that are known to affect sympathetic activity.
“In addition, the present study was designed to avoid traditional confounding factors that are known to affect sympathetic activity.4,7”
From Sympathetic Neural Activation in Nondiabetic Metabolic Syndrome and Its Further Augmentation by Hypertension (2004) · cites this paper as [7]
MS components such as visceral obesity, peripheral insulin resistance, and reactive hyperinsulinemia have been found to result in sympathetic hyperactivity.
“First, MS components such as visceral obesity, peripheral insulin resistance, and reactive hyperinsulinemia have been found to result in sympathetic hyperactivity.[5][6][7]”
From Sympathetic Neural Activation in Nondiabetic Metabolic Syndrome and Its Further Augmentation by Hypertension (2004) · cites this paper as [7]
The coexistence of EHT and type 2 diabetes results in an even greater sympathetic neural activation than that seen in EHT or type 2 diabetes alone.
“In addition, the coexistence of EHT and type 2 diabetes results in an even greater sympathetic neural activation than that seen in EHT or type 2 diabetes alone.7”
From Sympathetic Neural Activation in Nondiabetic Metabolic Syndrome and Its Further Augmentation by Hypertension (2004) · cites this paper as [7]
Within each of the four groups, there was no significant correlation between sympathetic nerve activity and arterial pressure.
“As previously shown in hypertensive and normotensive populations, 4,7 there was no significant correlation within any of the groups between sympathetic nerve activity and arterial pressure (at least PϾ0.06).”
From Sympathetic Neural Activation in Nondiabetic Metabolic Syndrome and Its Further Augmentation by Hypertension (2004) · cites this paper as [7]
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References 44 · Cited by 305
Research works printed but not linked: 1
- Wallin BG. Assessment of sympathetic mechanisms for recordings of postganglionic efferent nerve traffic. In: Hainsworth R, Mark AL, eds. Cardiovascular Reflex Control in Health and Disease. Philadelphia, Pa: WB Saunders; 1993:65-93.
- Authors
- Huggett, R. J., Scott, E. M., Gilbey, S. G., Stoker, J. B., Mackintosh, A. F., & Mary, D. A. S. G.
- Affiliations
- St James's University Hospital (GB)
- Venue
- Circulation
- Published
- 2003-12-23
- Volume
- 108
- Issue
- 25
- Pages
- 3097-3101
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2157049654
- Cited by
- 305
- References
- 44
- Citations by year
- 2026: 8 · 2025: 9 · 2024: 13 · 2023: 21 · 2022: 12 · 2021: 19 · 2020: 20 · 2019: 19 · 2018: 14 · 2017: 7 · 2016: 15 · 2015: 21 · 2014: 22 · 2013: 26 · 2012: 21
- FWCI
- 3.53
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Keywords
- type 2 diabetes, essential hypertension, sympathetic activity, muscle sympathetic nerve activity, plasma insulin, cardiovascular risk
- MeSH terms
- Diabetes Mellitus, Type 2, Female, Humans, Hypertension, Male, Middle Aged, Muscles, Sympathetic Nervous System
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