1. ¹Institute for Cardiovascular Research, Vrije Universiteit and Departments of Medicine and Nephrology, VU medical centre Amsterdam, The Netherlands
2. ²Cardiovascular Research Institute Maastricht, Maastricht University, Department of Pharmacology, The Netherlands
3. ³Sint Franciscus Gasthuis, Rotterdam, The Netherlands
4. ⁴Franciscus Ziekenhuis Roosendaal, The Netherlands
5. ⁵Katholieke Universiteit Leuven, Belgium

Correspondence: Dr FJ van Ittersum, Department of Nephrology, VU Medical Centre, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands. E-mail: fj.vanittersum@vumc.nl

Received 4 February 2004; Accepted 28 April 2004; Published online 3 June 2004.

Abstract

Type I diabetic patients (DM-1) with an elevated urinary albumin excretion (UAE>30 mg/24 h) have a high cardiovascular risk. However, DM-1 patients with normal UAE have incipient abnormalities of the cardiovascular and nervous systems, such as elevations of blood pressures, increases in arterial stiffness and deterioration of autonomic nervous function. We studied the interrelationships of these abnormalities in normoalbuminuric DM-1 patients. In 76 patients, we performed two cardiovascular reflex tests (deep in- and expiration test (IE test) and lying-to-standing test (LS test)), and determined aortic pulse wave velocity (PWV), local arterial compliances of the common carotid, femoral and brachial arteries, and 24-h blood pressures. The RRmax value of the LS test was associated with aortic PWV (negatively) and the compliance coefficients of the carotid, femoral and brachial arteries. Per 100-ms increase in RRmax, pulse wave velocity decreased by 0.39 m/s, compliance coefficients of the carotid, femoral and brachial arteries increased by 0.06, 0.08 and 0.05 mm²/kPa, respectively. These associations were independent of age, 24-h mean arterial pressure and 24-h heart rate. Increases in arterial stiffness were associated with increases in 24-h systolic and pulse pressure (per 1 m/s increase in PWV, systolic and pulse pressure increased by 2.1 and 1.7 mmHg, respectively). In normoalbuminuric DM-1 patients, deterioration of autonomic nervous function is associated with an increase in arterial stiffness, which, in turn, was associated with, and may cause, increased systolic and pulse pressure. These findings suggest that preventive strategies targeting autonomic dysfunction may reduce cardiovascular morbidity in diabetes.