scholarly journals New Indices of Endothelial Function Measured by Digital Thermal Monitoring of Vascular Reactivity: Data from 6084 Patients Registry

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Morteza Naghavi ◽  
Albert A. Yen ◽  
Alex W. H. Lin ◽  
Hirofumi Tanaka ◽  
Stanley Kleis
Keyword(s):  
Blood Pressure ◽  
Endothelial Function ◽  
Diastolic Blood Pressure ◽  
Vascular Reactivity ◽  
Cardiovascular Health ◽  
Patient Characteristics ◽  
Reactivity Index ◽  
Thermal Monitoring ◽  
Reactivity Measurement ◽  
Large Patient

Background. Endothelial function is viewed as a barometer of cardiovascular health and plays a central role in vascular reactivity. Several studies showed digital thermal monitoring (DTM) as a simple noninvasive method to measure vascular reactivity that is correlated with atherosclerosis risk factors and coronary artery disease. Objectives. To further evaluate the relations between patient characteristics and DTM indices in a large patient registry. Methods. DTM measures were correlated with age, sex, heart rate, and systolic and diastolic blood pressure in 6084 patients from 18 clinics. Results. DTM vascular reactivity index (VRI) was normally distributed and inversely correlated with age (r=-0.21, p<0.0001). Thirteen percent of VRI tests were categorized as poor vascular reactivity (VRI < 1.0), 70 percent as intermediate (1.0 ≤ VRI < 2.0), and 17 percent as good (VRI ≥ 2.0). Poor VRI (<1.0) was noted in 6% of <50 y, 10% of 50–70 y, and 18% of ≥70 y. In multiple linear regression analyses, age, sex, and diastolic blood pressure were significant but weak predictors of VRI. Conclusions. As the largest database of finger-based vascular reactivity measurement, this report adds to prior findings that VRI is a meaningful physiological marker and reflects a high level of residual risk found in patients currently under care.

scholarly journals Serum Adipocyte Fatty Acid-Binding Protein Level is Negatively Associated with Vascular Reactivity Index Measured by Digital Thermal Monitoring in Kidney Transplant Patients

Metabolites ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. 159 ◽  
Author(s):  
Tai-Li Chen ◽  
Ming-Che Lee ◽  
Ching-Chung Ho ◽  
Bang-Gee Hsu ◽  
Jen-Pi Tsai
Keyword(s):  
Fatty Acid ◽  
Endothelial Function ◽  
Kidney Transplant ◽  
Vascular Reactivity ◽  
Fatty Acid Binding Protein ◽  
Reactivity Index ◽  
Thermal Monitoring ◽  
Fatty Acid Binding ◽  
Negatively Associated ◽  
Acid Binding Protein

Adipocyte fatty acid-binding protein (A-FABP) is abundantly found in mature adipocytes and is involved in cardiovascular disease. Our aim is to investigate the association between serum A-FABP levels and endothelial function among kidney transplant (KT) patients. Fasting blood samples were obtained from 80 KT patients. Serum A-FABP levels were measured using a commercially available enzyme immunoassay kit. Endothelial function and vascular reactivity index (VRI) were measured using digital thermal monitoring test. In this study, VRI < 1.0, VRI 1.0–1.9, and VRI ≥ 2.0 were defined as poor, intermediate, and good vascular reactivity, respectively. There were 12 (15.0%), 30 (37.5%), and 38 (47.5%) KT patients categorized as having poor, intermediate, and good vascular reactivity, respectively. Increased serum levels of alkaline phosphatase (p = 0.012), γ-glutamyltranspeptidase (GGT; p = 0.032), and A-FABP (p < 0.001) were associated with decreased vascular reactivity. Multivariable forward stepwise linear regression analysis revealed that age (β = −0.283, adjusted R2 change = 0.072; p = 0.003) and serum log-A-FABP level (β = −0.514, adjusted R2 change = 0.268; p < 0.001) were significantly associated with VRI values in KT patients. We concluded that serum fasting A-FABP level is negatively associated with VRI values and plays a role in endothelial dysfunction of KT patients.

scholarly journals Serum Osteocalcin Level is Negatively Associated with Vascular Reactivity Index by Digital Thermal Monitoring in Kidney Transplant Recipients

Medicina ◽  
2020 ◽  
Vol 56 (8) ◽  
pp. 400
Author(s):  
Lin Lin ◽  
Liang-Te Chiu ◽  
Ming-Che Lee ◽  
Bang-Gee Hsu
Keyword(s):  
Endothelial Function ◽  
Kidney Transplant ◽  
Vascular Reactivity ◽  
Advanced Age ◽  
Reactivity Index ◽  
Enzyme Linked Immunosorbent Assay ◽  
Serum Osteocalcin ◽  
Thermal Monitoring ◽  
Osteocalcin Level ◽  
Serum Osteocalcin Level

Background and Objectives: Osteocalcin is the most abundant noncollagenous protein in bone matrix, which is considered a marker of bone formation. Previous studies indicate that circulating osteocalcin can be expressed by osteoblasts and even by osteoblast-like cells in vessel walls, and it is often associated with arterial stiffness. Our study aims to examine the potential association between osteocalcin levels and endothelial function among kidney transplant (KT) recipients. Materials and Methods: Fasting blood samples were obtained from 68 KT recipients. To measure the endothelial function and vascular reactivity index (VRI), a digital thermal monitoring test (VENDYS) was used. A commercial enzyme-linked immunosorbent assay kit was also utilized to measure serum total osteocalcin levels. In this study, a VRI of less than 1.0 indicated poor vascular reactivity; a VRI of 1.0–2.0 indicated intermediate vascular reactivity; and a VRI of 2.0 or higher indicated good vascular reactivity. Results: Our findings show that 8 KT recipients (11.8%) had poor vascular reactivity (VRI < 1.0), 26 (38.2%) had intermediate vascular reactivity (1.0 ≤ VRI < 2.0), and 34 (50%) had good vascular reactivity. Increased serum osteocalcin levels (p < 0.001) were found to be associated with poor vascular reactivity. Advanced age (r = −0.361, p = 0.002), serum alkaline phosphate level (r = −0.254, p = 0.037), and log-transformed osteocalcin levels (r = − 0.432, p < 0.001) were identified to be negatively correlated with VRI in KT recipients. Multivariable forward stepwise linear regression analysis revealed that the serum level of osteocalcin (β = −0.391, adjusted R2 change = 0.174; p < 0.001) and advanced age (β = −0.308, adjusted R2 change = 0.084; p = 0.005) were significantly and independently associated with VRI in KT recipients. Conclusions: Higher serum osteocalcin level was associated with lower VRI and poorer endothelial dysfunction among KT recipients.

scholarly journals Raynaud Phenomenon in Systemic Sclerosis: Does Digital Thermal Monitoring Correlate to Specific Nailfold Videocapillaroscopy Abnormalities?

2020 ◽  
pp. jrheum.191371
Author(s):  
Julie Thomas ◽  
Mislav Radic ◽  
Jordan R. Tucker ◽  
Rebecca Overbury ◽  
Tracy M. Frech
Keyword(s):  
Systemic Sclerosis ◽  
Vascular Function ◽  
Vascular Reactivity ◽  
Clinical Care ◽  
Density Measurement ◽  
Nonparametric Tests ◽  
Reactivity Index ◽  
Thermal Monitoring ◽  
Nailfold Videocapillaroscopy ◽  
Raynaud Phenomenon

Objective Early diagnosis of systemic sclerosis (SSc) is imperative, and Raynaud phenomenon (RP) is an important component of progressive vasculopathy. Nailfold videocapillaroscopy (NVC) is a well-established tool that can quantify structural vascular abnormalities. Digital thermal monitoring (DTM) assesses microvascular functional dysfunction related to thermoregulation. In this study, we investigated the correlation of NVC patterns and DTM variables in patients with SSc. Methods Patients with SSc according to the 2013 American College of Rheumatology/European League Against Rheumatism criteria who consented and enrolled in the clinical care registry had NVC and DTM performed. For NVC, the number of capillaries (density), measurement of apical diameter (dimension), presence or absence of hemorrhages, and number of abnormal shapes were assessed to categorize 3 different qualitative patterns: early, active, and late. For DTM, Doppler ultrasound hyperemic, low frequency, blood velocity of radial artery, and fingertip vascular function were assessed, and a vascular reactivity index (VRI) measurement was automated. Statistical evaluation was performed by nonparametric tests to assess the correlation of NVC and VRI. Results Thirty-one SSc subjects with interpretable NVC and DTM performed on the same day were included in the study. VRI was progressively higher in SSc patients with early, active, and late NVC patterns of microangiopathy (P < 0.0001). There was a significant negative correlation between VRI and microhemorrhages scores (r = –0.363, P = 0.044). Conclusion Our study suggests that more advanced vasculopathy correlates to reduced microvascular function as detected by DTM and more advanced structural abnormalities detected by NVC. NVC and DTM may provide different aspects of vasculopathy quantification and complement each other as investigative tools.

scholarly journals The association of nadir CD4-T cell count and endothelial dysfunction in a healthy HIV cohort without major cardiovascular risk factors

2020 ◽  
Vol 8 ◽  
pp. 205031212092489
Author(s):  
Emad Mogadam ◽  
Kevin King ◽  
Kimberly Shriner ◽  
Karen Chu ◽  
Anders Sondergaard ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Endothelial Dysfunction ◽  
Vascular Reactivity ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Lipoprotein Cholesterol ◽  
Reactivity Index ◽  
Low Density ◽  
Low Density Lipoprotein Cholesterol

Objectives: HIV-infected population may have increased risk of cardiovascular disease. The prevalence of traditional cardiovascular disease risk factors such as hypertension, diabetes and dyslipidemia in HIV-infected individuals has made it difficult to assess the direct effects of HIV and immune factors on endothelial dysfunction and associated increased risk of atherosclerosis. The purpose of this study was to investigate indicators of endothelial dysfunction in an HIV cohort without hypertension and diabetes. Methods: We studied 19 HIV-infected patients between the ages of 25–76 years old with effectively suppressed viral load and without diagnosis of hypertension or diabetes. Endothelial function was measured by digital thermal monitoring of vascular reactivity using the VENDYS technique. Endothelial function was reported as vascular reactivity index. Systolic blood pressure and diastolic blood pressure at the time of VENDYS test were measured and latest lipid panels were recorded. The association between vascular reactivity index and CD4-T cells count, different antiretroviral therapy types (non-nucleoside reverse transcriptase, nucleoside reverse transcriptase, protease inhibitors, integrase inhibitors), vitamins use, systolic blood pressure, diastolic blood pressure, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol was investigated. Results: Mean vascular reactivity index was 1.87 ± 0.53. Vascular reactivity index, marker of endothelial dysfunction, showed a significant correlation with lower nadir CD4 count (p = 0.003) as well as low-density lipoprotein cholesterol (p = 0.02). No additional significant correlation between vascular reactivity index and the rest of the investigated variables was found. Conclusion: Vascular reactivity index, a clinical predictor of endothelial dysfunction, is associated with lower nadir CD4-T cell and low-density lipoprotein cholesterol in HIV-infected men with no history of hypertension or diabetes and before clinical evidence of cardiovascular disease.

scholarly journals Cocoa flavanol intake improves endothelial function and Framingham Risk Score in healthy men and women: a randomised, controlled, double-masked trial: the Flaviola Health Study

2015 ◽  
Vol 114 (8) ◽  
pp. 1246-1255 ◽  
Author(s):  
Roberto Sansone ◽  
Ana Rodriguez-Mateos ◽  
Jan Heuel ◽  
David Falk ◽  
Dominik Schuler ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Pulse Wave Velocity ◽  
Endothelial Function ◽  
Cardiovascular Health ◽  
Framingham Risk Score ◽  
Pulse Wave ◽  
Men And Women ◽  
Framingham Risk ◽  
Randomised Controlled

AbstractCocoa flavanol (CF) intake improves endothelial function in patients with cardiovascular risk factors and disease. We investigated the effects of CF on surrogate markers of cardiovascular health in low risk, healthy, middle-aged individuals without history, signs or symptoms of CVD. In a 1-month, open-label, one-armed pilot study, bi-daily ingestion of 450 mg of CF led to a time-dependent increase in endothelial function (measured as flow-mediated vasodilation (FMD)) that plateaued after 2 weeks. Subsequently, in a randomised, controlled, double-masked, parallel-group dietary intervention trial (Clinicaltrials.gov: NCT01799005), 100 healthy, middle-aged (35–60 years) men and women consumed either the CF-containing drink (450 mg) or a nutrient-matched CF-free control bi-daily for 1 month. The primary end point was FMD. Secondary end points included plasma lipids and blood pressure, thus enabling the calculation of Framingham Risk Scores and pulse wave velocity. At 1 month, CF increased FMD over control by 1·2 % (95 % CI 1·0, 1·4 %). CF decreased systolic and diastolic blood pressure by 4·4 mmHg (95 % CI 7·9, 0·9 mmHg) and 3·9 mmHg (95 % CI 6·7, 0·9 mmHg), pulse wave velocity by 0·4 m/s (95 % CI 0·8, 0·04 m/s), total cholesterol by 0·20 mmol/l (95 % CI 0·39, 0·01 mmol/l) and LDL-cholesterol by 0·17 mmol/l (95 % CI 0·32, 0·02 mmol/l), whereas HDL-cholesterol increased by 0·10 mmol/l (95 % CI 0·04, 0·17 mmol/l). By applying the Framingham Risk Score, CF predicted a significant lowering of 10-year risk for CHD, myocardial infarction, CVD, death from CHD and CVD. In healthy individuals, regular CF intake improved accredited cardiovascular surrogates of cardiovascular risk, demonstrating that dietary flavanols have the potential to maintain cardiovascular health even in low-risk subjects.

scholarly journals Biological Pathways of Long-Term Visit-to-Visit Blood Pressure Variability in the American Population: Cardiovascular Health Study and Women’s Health Initiatives

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Mohammed F. Faramawi ◽  
Mohammed S. Orloff ◽  
Robert Delongchamp ◽  
Yan Wang ◽  
Eleanor Feingold ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Women’S Health ◽  
Women's Health ◽  
Diastolic Blood Pressure ◽  
Blood Pressure Variability ◽  
Cardiovascular Health ◽  
Biological Pathways ◽  
Arterial Blood ◽  
Health Initiatives

Studies reported a positive relationship between visit-to-visit blood pressure variability (VVBPV) and cardiovascular morbidity and mortality independently of the mean arterial blood pressure across clinical visits. The literature is scarce on the genes and biological mechanisms that regulate long-term VVBPV. We sought to identify biological pathways that regulate visit-to-visit blood pressure variability. We used phenotypic and genotype data from the Women’s Health Initiatives and Cardiovascular Health Studies. We defined VVBPV of systolic and diastolic blood pressure phenotypes as the standard deviation about the participant’s regression line with systolic and diastolic blood pressure regressed separately across visits. We imputed missing genotypes and then conducted a genome-wide association analysis to identify genomic variants related to the VVBPV and detect biological pathways. For systolic VVBPV, we identified a neurological pathway, the GABAergic pathway (P values = 1.1E − 2), and a vascular pathway, the RAP1 signaling pathway (P values = 5.8E − 2). For diastolic VVBPV, the hippo signaling (P values = 4.1E − 2), CDO myogenesis (P values = 7.0E − 2), and O-glycosylation of TSR domain-containing protein pathways (P values = 9.0E − 2) were the significant pathways. Future studies are warranted to validate these results. Further understanding of the roles of the genes regulating the identified pathways will help researchers to improve future pharmacological interventions to treat VVBPV in clinical practice.

scholarly journals “Beet” the cold: beetroot juice supplementation improves peripheral blood flow, endothelial function, and anti-inflammatory status in individuals with Raynaud’s phenomenon

2019 ◽  
Vol 127 (5) ◽  
pp. 1478-1490 ◽  
Author(s):  
Anthony I. Shepherd ◽  
Joseph T. Costello ◽  
Stephen J. Bailey ◽  
Nicolette Bishop ◽  
Alex J. Wadley ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Flow ◽  
Endothelial Function ◽  
Diastolic Blood Pressure ◽  
Raynaud’S Phenomenon ◽  
Raynaud's Phenomenon ◽  
Beetroot Juice ◽  
Local Cooling ◽  
Inflammatory Status ◽  
Anti Inflammatory

Raynaud’s phenomenon (RP) is characterized by recurrent transient peripheral vasospasm and lower nitric oxide (NO) bioavailability in the cold. We investigated the effect of nitrate-rich beetroot juice (BJ) supplementation on 1) NO-mediated vasodilation, 2) cutaneous vascular conductance (CVC) and skin temperature (Tsk) following local cooling, and 3) systemic anti-inflammatory status. Following baseline testing, 23 individuals with RP attended four times, in a double-blind, randomized crossover design, following acute and chronic (14 days) BJ and nitrate-depleted beetroot juice (NDBJ) supplementation. Peripheral Tsk and CVC were measured during and after mild hand and foot cooling, and during transdermal delivery of acetylcholine and sodium nitroprusside. Markers of anti-inflammatory status were also measured. Plasma nitrite concentration ([nitrite]) was increased in the BJ conditions ( P < 0.001). Compared with the baseline visit, thumb CVC was greater following chronic-BJ (Δ2.0 flux/mmHg, P = 0.02) and chronic-NDBJ (Δ1.45 flux/mmHg, P = 0.01) supplementation; however, no changes in Tsk were observed ( P > 0.05). Plasma [interleukin-10] was greater, pan endothelin and systolic and diastolic blood pressure (BP) were reduced, and forearm endothelial function was improved, by both BJ and NDBJ supplementation ( P < 0.05). Acute and chronic BJ and NDBJ supplementation improved anti-inflammatory status, endothelial function and blood pressure (BP). CVC following cooling increased post chronic-BJ and chronic-NDBJ supplementation, but no effect on Tsk was observed. The key findings are that beetroot supplementation improves thumb blood flow, improves endothelial function and anti-inflammatory status, and reduces BP in people with Raynaud’s. NEW & NOTEWORTHY This is the first study to examine the effect of dietary nitrate supplementation in individuals with Raynaud’s phenomenon. The principal novel findings from this study were that both beetroot juice and nitrate-depleted beetroot juice 1) increased blood flow in the thumb following a cold challenge; 2) enhanced endothelium-dependent and -independent vasodilation in the forearm; 3) reduced systolic and diastolic blood pressure, and pan-endothelin concentration; and 4) improved inflammatory status in comparison to baseline.

Abstract MP16: Reallocating Sedentary Behavior With Sleep or Physical Activity is Associated With Favorable Cardiovascular Health in the Multi-Ethnic Study of Atherosclerosis: MESA

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Charles German ◽  
Nour Makarem ◽  
Jason Fanning ◽  
Susan Redline ◽  
Tali Elfassy ◽  
...  
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Blood Pressure ◽  
Sedentary Behavior ◽  
Diastolic Blood Pressure ◽  
Cardiovascular Health ◽  
Sedentary Time ◽  
Vigorous Physical Activity ◽  
Ethnic Study ◽  
The Mean

Introduction: Sleep, sedentary behavior, and physical activity are each independently associated with cardiovascular health (CVH). However, many studies have investigated these relationships in isolation even though a change in any one given behavior will affect the time spent in the others. It is unknown how reallocating time in sedentary behavior with sleep or physical activity effects overall CVH in a diverse cohort of men and women at risk of cardiovascular disease (CVD). Hypothesis: Reallocating 30 minutes of sedentary time with sleep, light (LIPA), or moderate to vigorous physical activity (MVPA) is associated with more favorable overall CVH due to improvements in risk factors for CVD. Methods: Data for this analysis were taken from the Multi-Ethnic Study on Atherosclerosis (MESA) Sleep Ancillary Study. Eligible participants (n= 1718) wore Actiwatch accelerometers for 24 hours a day, and had at least 3 days of valid accelerometry. Time spent in sleep, sedentary behavior, LIPA, and MVPA was determined based on an established algorithm. The American Heart Association’s life simple 7 was used to represent the CVH score after excluding the physical activity component, with higher scores indicating more favorable CVH. All components were ascertained from MESA exam 5. Isotemporal substitution modeling was conducted to examine the effect of substituting 30 minutes of sedentary time for an equivalent amount of sleep, LIPA, or MVPA. Results: The mean age of participants was 68.3, 54.0% were female and 38.6% were white. The mean CVH score was 5.9 (95%CI: 5.8-6.0). On average, participants spent 499.3 minutes/day in sedentary time, 415.3 minutes/day in LIPA, 26.0 minutes/day in MVPA, and 388.2 minutes/day sleeping. Reallocating 30 minutes of sedentary time to sleep, LIPA, and MVPA was associated with a significantly higher CVH score [β(SE): 0.077(0.023), 0.039(0.017), and 0.485(0.065) respectively]. Reallocating 30 minutes of sedentary time to sleep was associated with lower BMI. Reallocating 30 minutes of sedentary time to LIPA was associated with higher diastolic blood pressure and total cholesterol, and lower BMI. Reallocating 30 minutes of sedentary time to MVPA was associated with lower systolic and diastolic blood pressure, and lower BMI. Conclusions: Our study demonstrates that sleep, LIPA, and MVPA are all positively associated with more favorable overall CVH and several key CVD risk factors. These findings underscore the importance of lifestyle modifications in improving CVH.

scholarly journals Clinical Bedside Tools to Assess Systemic Sclerosis Vasculopathy: Can digital thermal monitoring and sublingual microscopy identify patients with digital ulcers?

2021 ◽  
pp. jrheum.201234
Author(s):  
Tracy M. Frech ◽  
Zhining Ou ◽  
Angela P. Presson
Keyword(s):  
Systemic Sclerosis ◽  
Vascular Reactivity ◽  
Rank Correlation ◽  
Boundary Region ◽  
Reactivity Index ◽  
Clinical Feature ◽  
Digital Ulcers ◽  
Thermal Monitoring ◽  
Irreversible Damage ◽  
Cross Sectional

Objective Sublingual microscopy assesses systemic sclerosis (SSc) vasculopathy. Digital thermal monitoring (DTM) may identify patients at risk for digital ulcer (DU). The purpose of this analysis was to assess sublingual microscopy and DTM in SSc patients with and with no previous DU in order to determine the utility of these clinical tools. Methods SSc registry patients with clinical data had both DTM and sublingual microscopy on the same day were included in this cross-sectional analysis. DTM quantifies vascular reactivity index (VRI). Sublingual microscopy measures longitudinal red blood cell fraction (RBC fract) and perfused boundary region (PBR). We evaluated the pairwise association between VRI, RBCfract and PBR in a monotonic relationship using Spearman’s rank correlation in the DU subset. Correlation coefficients (rs) and their 95% confidence intervals (CIs) were reported. Results Ninety patients were included; 29 had digital pits and/or active DU and 61 never had a DU. The only significant clinical feature associated with DU was modified Rodnan skin score (p=0.003) with DU being higher. The VRI was lower in patients with DU (p=0.01). The higher RBCfract the lower PBR (rs =- 0.71, 95% CI: -0.86, -0.47, p<0.001). VRI was not associated with RBCfract or PBR (p=0.24 or 0.55, respectively) in the DU patients. Conclusion DTM is a useful tool for assessing SSc-DU. While sublingual microscopy measurements did not significantly correlate to VRI in SSc-DU patients, a longitudinal study may be more helpful in capturing vasculopathy activity prior to possibly irreversible damage.

Altered Blood Pressure Reactivity in Adolescent Diabetics

PEDIATRICS ◽  
1994 ◽  
Vol 93 (4) ◽  
pp. 616-621
Author(s):  
Kathleen M. Newkumet ◽  
Monica Martin Goble ◽  
Reuben B. Young ◽  
Paul B. Kaplowitz ◽  
Richard M. Schieken
Keyword(s):  
Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Vascular Reactivity ◽  
Type I Diabetes ◽  
Glycosylated Hemoglobin ◽  
Isometric Exercise ◽  
Diabetes Duration ◽  
Type I ◽  
Vascular Changes ◽  
And Control

Objective. We examined hemodynamic responses to a variety of physiologic stimuli in 14 normotensive adolescents with type I diabetes and 45 healthy controls to determine whether structural vascular changes contribute to a reduced vasodilator capacity in adolescent diabetics. We asked, in adolescents with type I diabetes: (1) Are structural vascular changes present? (2) Are changes in the systemic vascular bed reflected in abnormal blood pressure regulation? and (3) Is abnormal vascular reactivity associated with either diabetes duration or control? Methodology. Diabetic subjects were outpatients treated at the Medical College of Virginia, ages 13 to 18 years. Diabetes duration averaged 7.5 years. Each subject underwent an echocardiogram, dynamic and isometric exercise testing, and forearm plethysmography. Results. Compared to controls, diabetic subjects had (1) higher systolic and diastolic blood pressure during dynamic and handgrip exercise, (2) decreased forearm vasodilator capacity in response to ischemia, and (3) an increased aortic peak velocity. Group diastolic filling abnormalities were found, but these did not persist after adjustment for heart rate. The following variables were related to both diabetes duration and control (average glycosylated hemoglobin): (1) diastolic blood pressure during dynamic exercise, (2) resting forearm vascular resistance, and (3) forearm vascular reactivity. In addition, diabetes duration correlated with isometric exercise diastolic blood pressure, and diabetes control correlated with resting diastolic blood pressure. Conclusion. In young diabetics we found that (1) abnormalities of the resistance vessels of the forearm may be present, (2) the degree of vascular change is related to diabetes duration and control, and (3) aortic distensibility may be impaired.

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