Insulin resistance influences 24h heart rate and blood pressure variabilities and cardiovascular autonomic modulation in normotensive healthy adults

Transcription

1 Insulin resistance influences 24h heart rate and blood pressure variabilities and cardiovascular autonomic modulation in normotensive healthy adults Ochoa JE 1, Correa M 2, Valencia AM 2, Gallo J 2, McEwen J 3, Bilo G 4, Salvi P 4, Aristizabal D 2, Parati G 1,4 1. Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Milan, Italy. 2. Clinical and Research Center, SICOR, Medellín, Colombia. 3. Corporación para Investigaciones Biologicas, Medellín, Colombia. 4. Department of Cardiology, S. Luca Hospital, Istituto Auxologico Italiano, Milan, Italy

2 Aim: To explore the relationship of IR with: 1-HR and BPV within the 24h 2-Cardiac BRS and Indices of autonomic CV modulation

3 Frequency (number of individuals) Methods: subjects Population study Medellín, Colombia Prevalence of CV risk factors in (n=800). Subjects with DBP 30 percentile of DBP distribution curve Diastolic BP (mmhg)

4 Methods: Subjects Further inclusion criteria : Normotensive 24h mean SBP/DBP 107/69 mmhg No history of HT or taking antihypertensive treatment Normoglicemic mean fasting glucose 76.1± 10.0 mg/dl Non-obese mean BMI ± 3.66 Kg/m 2 Healthy adults mean age 48±10 yrs, no previous history of CVD. A total of 90 subjects were included

5 Methods: Assessment of IR HOMA-Index = ((glycemia (mg/dl)/18) x insulinemia(uu/ml)/22.5). subjects were classified into tertiles based on HOMA-IR values Matthews DR, et al. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28(7):

6 Methods: BP measurement (24h ABPM) HR, SBP and DBP levels were averaged over the 24-h, day- and night-time Day-to-night dipping of HR, SBP and DBP were calculated Daytime Night-time Mobil-O-Graph NG, IEM, Stolberg, Germany.

7 Methods: assessment of BPV within the 24h BPV was assessed separately for SBP and DBP as: 24-h SD Day-time SD Night-time SD Weighted 24h SD (wsd) Bilo G, Parati G, et al. A new method for assessing 24-h blood pressure variability after excluding the contribution of nocturnal blood pressure fall. J hypertens. 2007;25(10):

8 Methods: assessment of autonomic cardiac modulation Protocol of hemodynamic assessment: 10 min beat-to beat BP and RRI recordings in supine position (Task Force Monitor, Graz, Austria) Time (min)

9 Methods: assessment of cardiac BRS Sequence method (Parati et al. 1988) Up Sequence Down Sequence

10 Methods: indices of autonomic cardiac modulation Frequency domain analysis of HRV (Spectral technique) LF, HF and RRI total power (PSD, ms 2 ) LF and HF in normalized units (%) LF/HF ratio Parati G, et al LF HF

11 Methods: Statistical analysis subjects were classified into HOMA-IR tertiles ANOVA to test differences in clinical, autonomic and hemodynamic parameters among tertiles of HOMA-Index. ANCOVA Adjusting for age, sex, smoking, and BMI

12 Results: Clinical characteristics by tertiles of HOMA-Index Variable All T1 (<0.94) (n=32) T2 ( ) (n=28) T3 (>1.90) (n=30) P value Age (years) ± ± ± ± BMI ± ± ± ± Sex (Male, %) Smokers (%) Fasting glucose (mg/dl) 76.17± ± ± ± Insulin (mu/ml) 8.7 ± ± ± ± HOMA-Index 1.69 ± ± ± ± Total Cholesterol (mg/dl) 201.9± ± ± ± HDL Cholesterol (mg/dl) 45.3 ± ± ± ± LDL Cholesterol (mg/dl) 129.2± ± ± ± Triglycerides (mg/dl) 153.6± ± ± ±

13 Results: Mean HR and BP levels by tertiles of HOMA (from 24h ABPM) Variable* T1 (<0.94) (n=32) T2 ( ) (n=28) T3 (>1.90) (n=30) adjusted p value Day HR (bpm) 71.8 ± ± ± Day SBP (mmhg) ± ± ± Day DBP (mmhg) 73.0 ± ± ± Day PP (mmhg) 34.8 ± ± ± Night HR (bpm) 59.3 ± ± ± Night SBP (mmhg) 93.6 ± ± ± Night DBP (mmhg) 63.5 ± ± ± Night PP (mmhg) 30.1 ± ± ± h HR (bpm) 68.3 ± ± ± h SBP (mmhg) ± ± ± h DBP (mmhg) 70.2 ± ± ± h PP (mmhg) 33.5 ± ± ±

14 Results: HR and BPV (from 24h ABPM) by tertiles of HOMA Variable* T1 (<0.94) (n=32) T2 ( ) (n=28) T3 (>1.90) (n=30) Adjust ed p value Day SBP SD (mmhg) 9.7 ± ± ± Day DBP SD (mmhg) 6.4 ± ± ± Day HR SD (bpm) 10.1 ± ± ± Night SBP SD (mmhg) 9.6 ± ± ± Night DBP SD (mmhg) 6.5 ± ± ± Night HR SD (bpm) 5.3 ± ± ± h SBP SD (mmhg) 11.9 ± ± ± h DBP SD (mmhg) 8.0 ± ± ± h HR SD (bpm) 11.1 ± ± ± SBP wsd 9.7 ± ± ± DBP wsd 6.5 ± ± ± HR dipping (bpm) 13.1 ± ± ± SBP dipping (mmhg) 14.4 ± ± ± DBP dipping (mmhg) 9.5 ± ± ±

15 Results: cardiac BRS by tertiles of HOMA-IR p= 0,045 p= 0,042 p= 0,045

16 Results: indices of autonomic CV modulation by tertiles of HOMA

17 Results: indices of autonomic CV modulation by tertiles of HOMA

18 Results: summary Insulin resistance was associated with: Ambulatory HR and SBP during day, night and 24h SBP variability (Day SBP SD, and 24h SBP wsd) RRI, HRV and HR dipping Cardiac BRS Indices of sympathetic CV modulation (LF/HF ratio) indices of parasympathetic CV modulation ( HF and TP)

19 CV outcomes and mortality Conclusion Insulin Resistance BRS Central Sympathetic drive HR and SBP during day, night and 24h BP variability and HRV HR dipping

20 Thanks for your attention.