Efficacy of Administration of an Angiotensin Converting Enzyme Inhibitor for Two Years on Autonomic and Peripheral Neuropathy in Patients with Diabetes Mellitus.
Triantafyllos DidangelosKonstantinos TziomalosCharalambos MargaritidisZisis KontoninasIoannis StergiouStefanos TsotoulidisEleni KarlaftiAlexandros MourouglakisApostolos I HatzitoliosPublished in: Journal of diabetes research (2017)
Aim. To evaluate the effect of quinapril on diabetic cardiovascular autonomic neuropathy (CAN) and peripheral neuropathy (DPN). Patients and Methods. Sixty-three consecutive patients with diabetes mellitus [43% males, 27 with type 1 DM, mean age 52 years (range 22-65)], definite DCAN [abnormal results in 2 cardiovascular autonomic reflex tests (CARTs)], and DPN were randomized to quinapril 20 mg/day (group A, n = 31) or placebo (group B, n = 32) for 2 years. Patients with hypertension or coronary heart disease were excluded. To detect DPN and DCAN, the Michigan Neuropathy Screening Instrument Questionnaire and Examination (MNSIQ and MNSIE), measurement of vibration perception threshold with biothesiometer (BIO), and CARTs [R-R variation during deep breathing [assessed by expiration/inspiration ratio (E/I), mean circular resultant (MCR), and standard deviation (SD)], Valsalva maneuver (Vals), 30 : 15 ratio, and orthostatic hypotension (OH)] were used. Results. In group A, E/I, MCR, and SD increased (p for all comparisons < 0.05). Other indices (Vals, 30 : 15, OH, MNSIQ, MNSIE, and BIO) did not change. In group B, all CART indices deteriorated, except Vals, which did not change. MNSIQ, MNSIE, and BIO did not change. Conclusions. Treatment with quinapril improves DCAN (mainly parasympathetic dysfunction). Improved autonomic balance may improve the long-term outcome of diabetic patients.
Keyphrases
- heart rate variability
- heart rate
- angiotensin converting enzyme
- escherichia coli
- end stage renal disease
- blood pressure
- double blind
- type diabetes
- angiotensin ii
- multidrug resistant
- ejection fraction
- chronic kidney disease
- glycemic control
- placebo controlled
- phase iii
- klebsiella pneumoniae
- open label
- cross sectional
- patient reported outcomes
- oxidative stress
- peritoneal dialysis
- clinical trial
- coronary artery
- randomized controlled trial
- phase ii
- metabolic syndrome
- insulin resistance
- skeletal muscle
- study protocol
- weight loss