FEATURES OF HEART RATE VARIABILITY (HRV) AND INDICATORS OF DAILY BLOOD PRESSURE MONITORING (ABPM) IN PATIENTS WITH DIABETES MELLITUS WITH DIFFERENT PATHOGENETIC SUBTYPES OF ISCHEMIC STROKE

Аннотация

INTRODUCTION [1] HRV and ABPM are invaluable tools for Ischemic stroke (IS) is a leading cause of morbidity evaluating these changes. This study aims to and mortality worldwide, with type 2 diabetes investigate the HRV and ABPM profiles in IS mellitus (T2DM) acting as a major risk factor for its patients with and without T2DM, focusing on their occurrence and severity. T2DM exacerbates distinct pathogenetic subtypes. vascular damage through mechanisms such as endothelial dysfunction, chronic inflammation, METHODS and oxidative stress, which may influence The study included 256 patients diagnosed with IS autonomic regulation and cardiovascular function https://www.theamericanjournals.com/index.php/tajmspr 20 THE USA JOURNALS THE AMERICAN JOURNAL OF MEDICAL SCIENCES AND PHARMACEUTICAL RESEARCH (ISSN – 2689-1026) VOLUME 06 ISSUE12 in the acute and pre-acute periods. Participants sympathetic activation. HF (High-Frequency were categorized into two groups: 1) main mroup Power): MG demonstrated reduced HF power (180 (MG) comprised 124 patients (67 women and 57 ± 34 ms² vs. 250 ± 42 ms², p < 0.01), reflecting men; mean age 51–79 years) with IS and blunted parasympathetic activity. LF/HF Ratio: concomitant T2DM. 2) Comparison Group (CG) MG patients exhibited a higher LF/HF ratio (2.1 ± Consisted of 132 patients (67 women and 70 men; 0.5) compared to CG (1.6 ± 0.4, p < 0.01), mean age 54–76 years) with IS but without T2DM. suggesting a pronounced autonomic imbalance Diagnostic criteria - IS was confirmed via clinical with sympathetic dominance. assessment and neuroimaging (MRI or CT). T2DM ABPM findings indicated notable differences diagnosis adhered to ADA guidelines, including between MG and CG, with MG patients showing fasting glucose and HbA1c levels. more pronounced blood pressure dysregulation: RESULTS Daytime Systolic BP (SBP): MG (143 ± 12 mmHg) was significantly higher than CG (135 ± 10 mmHg, T2DM in MG was associated with poorly controlled p < 0.001). Daytime Diastolic BP (DBP): MG glycemic status, with an average fasting glucose patients also showed elevated DBP levels (89 ± 7 level of 9.8 ± 2.4 mmol/L and mean HbA1c of 8.1 ± mmHg vs. 82 ± 6 mmHg, p < 0.001). Nighttime BP: 1.2%. These metrics significantly differed from CG Both SBP and DBP were elevated in MG (mean SBP: (fasting glucose: 5.6 ± 0.7 mmol/L, HbA1c: 5.4 ± 137 ± 11 mmHg, DBP: 85 ± 6 mmHg) compared to 0.8%, both p < 0.001). Additionally, MG patients CG (SBP: 128 ± 9 mmHg, DBP: 78 ± 5 mmHg, p < presented higher baseline levels of total 0.001). cholesterol (6.1 ± 1.4 mmol/L vs. 5.3 ± 1.2 mmol/L, p < 0.01) and triglycerides (2.3 ± 0.6 mmol/L vs. BP variability was significantly greater in MG, with 1.7 ± 0.5 mmol/L, p < 0.01). a standard deviation of SBP at 15 ± 3 mmHg compared to 12 ± 2 mmHg in CG (p < 0.01). MG HRV analysis revealed distinct differences patients had increased diurnal BP variability, with between MG and CG, reflecting significant 68% exceeding normal thresholds compared to autonomic dysregulation in diabetic patients. 45% in CG (p < 0.01). Time-Domain Indices SDNN (Standard Deviation of NN intervals): MG patients showed reduced Nocturnal Dipping Status the "non-dipper" values (92 ± 15 ms) compared to CG (108 ± 17 ms, pattern, characterized by <10% nocturnal BP p < 0.01). This reduction indicates diminished reduction, was observed in 65% of MG patients overall heart rate variability, a marker of compared to 38% of CG patients (p < 0.01). A compromised autonomic regulation. RMSSD (Root "reverse dipper" pattern, where nighttime BP Mean Square of Successive Differences): MG exceeds daytime BP, was more prevalent in MG patients had lower RMSSD values (28 ± 6 ms) (18%) than in CG (5%, p < 0.05). compared to CG (36 ± 8 ms, p < 0.01), highlighting - MG patients exhibited significantly higher pulse reduced parasympathetic activity. pressure (56 ± 8 mmHg) compared to CG (48 ± 6 Frequency-Domain Indices: LF (Low-Frequency mmHg, p < 0.01), indicating increased arterial Power): Both groups exhibited increased LF values stiffness and a greater cardiovascular risk burden. during the acute stroke phase, but MG patients Differences in HRV and ABPM parameters were showed significantly higher values (725 ± 98 ms² further analyzed across the three major vs. 640 ± 86 ms², p < 0.01), indicating heightened pathogenetic subtypes of IS: Atherothrombotic https://www.theamericanjournals.com/index.php/tajmspr 21 THE USA JOURNALS THE AMERICAN JOURNAL OF MEDICAL SCIENCES AND PHARMACEUTICAL RESEARCH (ISSN – 2689-1026) VOLUME 06 ISSUE12 Stroke - Predominant in both groups (MG: 52%, particularly in HF power (160 ± 30 ms² vs. 230 ± CG: 47%). MG patients demonstrated greater BP 35 ms², p < 0.01), indicating severe variability (mean SBP SD: 16 ± 3 mmHg vs. 13 ± 2 parasympathetic dysfunction. Lacunar subtype mmHg, p < 0.01) and higher LF/HF ratios (2.3 ± 0.4 was associated with the highest BP variability vs. 1.8 ± 0.3, p < 0.01). Cardioembolic Stroke - among MG patie