Dr. M. Kempler, Dr. A. Körei A, Dr. Z Putz , Dr. O. Vági, Dr. N. Hajdú, Dr. I. Istenes , Prof. Dr. P. Kempler
1st Department of Medicine, Semmelweis University, Budapest, Hungary
Introduction: Diagnosis of cardiovascular autonomic neuropathy (CAN) is still based on Ewing’s cardiovascular reflex tests, but the new guidelines don’t recommend the examination of the diastolic blood pressure response by the handgrip test. In our previous study, an inverse relationship between handgrip test abnormality and the presence of hypertension was established. Furthermore, it is well known that long lasting hypertension leads to left ventricle hypertrophy, which is an independent risk factor for carido- and cerebrovascular morbidity and mortality.
In this study we aimed to find correlations between hypertension, the handgrip test and echocardiograph parameters.
Patients and methods: Our study involved 83 patients with diabetes (mean age: 62.9±11 years; 43.9% male; 9.7% with type 1 diabetes; 91.4% with hypertension; HbA1c: 7.5±1.5%; BMI: 31.3±4.6 kg/m2). Cardiovascular autonomic neuropathy was assessed by Ewing’s standard reflex tests, and all patients had an echocardiographic examination.
Results: Cardiovascular autonomic neuropathy was confirmed in 38 cases (46.3%), handgrip tests were positive in 31 patients (37.8%). There was a significant correlation between the measured diastolic blood pressure rising in the handgrip test and the left ventricle end systolic (r=0.247 p<0.05) and end diastolic (r=0.304 p<0.05) diameter. The rising of the diastolic blood pressure showed an inverse proportion to the E/Ea value which is a feature for left ventricle compliance, but the correlation was not significant (r=-0.346 p=0.06). There was no correlation with the posterior wall thickness (r=0.125, p=0.35), with the left ventricle outflow tracts speed-time integral (LVOT-VTI) or with the left ventricle outflow tracts maximal speed (LVOT-vmax) (r=0.429, p=0.12 and r=0.322, p=0.36).
Conclusion: There is a univocal correlation between diastolic blood pressure rising measured with the handgrip test and the left ventricle end systolic and end diastolic diameters. Our data gives us more evidence on hypertension and its end organ damage and the correlation between the handgrip test.
Doctoral School: Clinical Medicine
Program: Molecular Genetics, Pathomechanism and Clinical Aspects of Metabolic Disorders
Supervisor: Zsuzsanna Putz
E-mail address: email@example.com