Objective: In diabetic patients, autonomic alterations are associated with hypertension. In healthy individuals, FFAs were shown to enhance sympathetic activity. We aimed to examine the influence of autonomic function alterations and FFA on hypertension and artery stiffness (pulse wave velocity, PWV) in overweight patients with normal or impaired glucose intolerance (NGT orIGT) or orally-treated type 2 diabetes.

Patients and Methods: We included 122 normotensive or well-controlled hypertensive patients;38 NGTs, 28 IGTs, 15 well-controlled T2Ds, 41 poorly-controlled T2Ds; meanage 41.1/41.7/53.8/54.2 years BMI 38.4/36.6/28.7/29.3 kg/m²; HbA1c 5.2/5.5/6.7/9.1% respectively. At fasting, cardiac vagal (HFnu-HR) and sympathetic (LFnu-HR) activity and sympatho-vagal balance (LF/HF-HR) were measured by spectral analysis of heart rate variations, PWV by applanation tonometry;FFA measured in IGTs and poorly-controlled T2Ds.

Results: Spectral indexes were similar in NGT, IGT and well-controlled T2D patients (meanHF-HRnu 68% andLF-HRnu 32%), but different vs. poorly-controlled T2Ds (37% and63%, respectively). Comparedto patients with HF-HR>median value, those with HF-HR<median were older (p<0.01), had lower BMI (p<0.05); similar glycemic status, HbA1c, PWV; higher LF/HF-HR(p<0.001) and more of them were hypertensive (40% vs. 20%, p<0.04), these differences remaining significant after adjustment for age, BMI, glycemic status. FFA correlated positively with LF-HR and negatively with HF-HR (p<0.04), also after multiple adjustment, in IGTs but not in poorly-controlled T2Ds (of whom49% were hypertensive).

Conclusion: In NGT, IGT orwell-controlled T2D overweight patients, lower vagal activity may contribute to hypertension independently from glycemic status, and FFA may reduce vagal activity and enhance sympathetic activity and thus promote hypertension while in poorly-controlled T2Ds this profile is more likely related to long-term hyperglycemia.


A. Rezki: None. M. Fysekidis: None. E. Cosson: Board Member; Self; Abbott, Boehringer Ingelheim Pharmaceuticals, Inc., LifeScan, Inc., Lilly Diabetes, Medtronic, Merck Sharp & Dohme Corp., Novartis France, Novo Nordisk A/S, Roche Diagnostics France, Sanofi. Research Support; Self; Air Liquide, Lilly Diabetes, Novo Nordisk A/S, Roche Diagnostics France, Roche Foundation, Sanofi. P. Valensi: None.

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