Intensive Blood Pressure Control Affects Cerebral Blood Flow in Type 2 Diabetes Mellitus Patients

被引:42
作者
Kim, Yu-Sok [3 ]
Davis, Shyrin C. A. T. [3 ]
Truijen, Jasper [3 ]
Stok, Wim J. [2 ,3 ]
Secher, Niels H. [4 ]
van Lieshout, Johannes J. [1 ,3 ]
机构
[1] Univ Amsterdam, Acad Med Ctr, Dept Internal Med, Special Med Care Unit, NL-1100 DE Amsterdam, Netherlands
[2] Univ Amsterdam, Acad Med Ctr, Dept Physiol, NL-1100 DE Amsterdam, Netherlands
[3] Univ Amsterdam, Acad Med Ctr, Ctr Heart Failure Res, Lab Clin Cardiovasc Physiol, NL-1100 DE Amsterdam, Netherlands
[4] Univ Copenhagen, Rigshosp, Copenhagen Muscle Res Ctr, Dept Anesthesia, DK-2100 Copenhagen, Denmark
关键词
autonomic function; blood pressure; cerebrovascular circulation; diabetes mellitus; hypertension; microvascular complication; CARDIAC-OUTPUT; COGNITIVE DECLINE; TRANSCRANIAL DOPPLER; OXYGEN-METABOLISM; AUTOREGULATION; VELOCITY; EXERCISE; REACTIVITY; HYPERTENSION; CIRCULATION;
D O I
10.1161/HYPERTENSIONAHA.110.160523
中图分类号
R6 [外科学];
学科分类号
1002 ; 100210 ;
摘要
Type 2 diabetes mellitus is associated with microvascular complications, hypertension, and impaired dynamic cerebral autoregulation. Intensive blood pressure (BP) control in hypertensive type 2 diabetic patients reduces their risk of stroke but may affect cerebral perfusion. Systemic hemodynamic variables and transcranial Doppler-determined cerebral blood flow velocity (CBFV), cerebral CO2 responsiveness, and cognitive function were determined after 3 and 6 months of intensive BP control in 17 type 2 diabetic patients with microvascular complications (T2DM+), in 18 diabetic patients without (T2DM-) microvascular complications, and in 16 nondiabetic hypertensive patients. Cerebrovascular reserve capacity was lower in T2DM+ versus T2DM- and nondiabetic hypertensive patients (4.6 +/- 1.1 versus 6.0 +/- 1.6 [P<.05] and 6.6 +/- 1.7 [P<.01], Delta% mean CBFV/mm Hg). After 6 months, the attained BP was comparable among the 3 groups. However, in contrast to nondiabetic hypertensive patients, intensive BP control reduced CBFV in T2DM- (58 +/- 9 to 54 +/- 12 cm . s(-1)) and T2DM+ (57 +/- 13 to 52 +/- 11 cm . s(-1)) at 3 months, but CBFV returned to baseline at 6 months only in T2DM-, whereas the reduction in CBFV progressed in T2DM+ (to 48 +/- 8 cm . s(-1)). Cognitive function did not change during the 6 months. Static cerebrovascular autoregulation appears to be impaired in type 2 diabetes mellitus, with a transient reduction in CBFV in uncomplicated diabetic patients on tight BP control, but with a progressive reduction in CBFV in diabetic patients with microvascular complications, indicating that maintenance of cerebral perfusion during BP treatment depends on the progression of microvascular disease. We suggest that BP treatment should be individualized, aiming at a balance between BP reduction and maintenance of CBFV. (Hypertension. 2011;57:738-745.)
引用
收藏
页码:738 / +
页数:15
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