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3 CARDIOVASCULAR AUTONOMIC NEUROPATHY IN HYPERTENSIVE PATIENT WITH PREDIABETES

Sinaka, G.D.1; Ismugi, 2; Pangaribuan, M.A.2; Soerarso, R.1; Hersunarti, N.1; Santoso, A.1; Siswanto, B.B.1

Journal of Hypertension: July 2018 - Volume 36 - Issue - p e1
doi: 10.1097/01.hjh.0000544368.50807.5d
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Background: The highest prevalence of prediabetes is in patients with hypertension. Furthermore, prediabetes has a higher risk of developing complications. One of the complications that is often underdiagnosed is Cardiovascular Autonomic Neuropathy (CAN).

Objective: The aim of this study is to determine the relationship between prediabetes and CAN in hypertensive patients.

Method: This cross-sectional study was conducted at National Police Hospital, Raden Said Sukamto Jakarta on subjects with hypertension. All subjects had their blood sugar profile (OGTT and HbA1C) and Heart Rhythm Variability (deep breathing, standing, and valsalva) examined. Based on the blood sugar profile, subjects were diagnosed with prediabetes (IFG, IGT, and high risk based on HbA1C level). Subjects presenting with a minimum 2 out of 3 abnormal RR ratio were diagnosed with CAN. Subjects with diabetes was excluded.

Results: There were 96 subjects included, with 18 of them were subjects with CAN. After adjusted with other factors (BMI, triglyceride and LDL level, IFG, and resting heart rate), age and IGT were significantly increase the incidence of CAN. (p = 0.013, OR 1.1, CI95% 1.023–1.221, and p = 0.020, OR 6.767, IK95% 1.349–33.941). In 38 prediabetic subjects, RR ratio were significantly lower in deep breathing test.

Conclusion: Subjects with prediabetes especially IGT have a higher risk of developing CAN. This finding shows acute episodes of hyperglycaemia in hypertensive patients have a major role in the development of CAN. Early sign of autonomic imbalance was already found in prediabetic patients, hence emphasizing the importance of screening and comprehensive management of prediabetes in hypertensive patients.

1Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia- National Cardiovascular Center Harapan Kita, Jakarta, Indonesia

2Department of Cardiology, National Police Hospital Raden Said Sukanto, Jakarta, Indonesia

Keywords: cardiovascular autonomic neuropathy, hypertension, prediabetes

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