Published Online
on December 15, 2003

A more recent version of this article appeared on December 23, 2003

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Submitted on April 3, 2003
Revised on September 19, 2003
Accepted on September 22, 2003

Impact of Type 2 Diabetes Mellitus on Sympathetic Neural Mechanisms in Hypertension

Robert J. Huggett MB, BS^*, Eleanor M. Scott BM, BS, MD, Stephen G. Gilbey BA, MD, John B. Stoker BSc, MB, ChB, Alan F. Mackintosh MA, MD, and David A.S.G. Mary MB, ChB, PhD

From the Department of Cardiology (R.J.H., J.B.S., A.F.M., D.A.S.G.M.) and Diabetes & Endocrinology (E.M.S., S.G.G.), St James’s University Hospital, Leeds, United Kingdom.

^* To whom correspondence should be addressed. E-mail: roberthuggett{at}hotmail.com.

Background--Essential hypertension (EHT) is a major cardiovascular risk factor, and the additional presence of type 2 diabetes mellitus (DM2) increases this risk. However, although the sympathetic nerve hyperactivity of EHT is known to play a role in cardiovascular risk, the level of sympathetic nerve activity is known neither in DM2 nor in hypertensive type 2 diabetic patients (EHT+DM2). Therefore, we planned to quantify the vasoconstrictor sympathetic nerve activity in patients with EHT+DM2 and with DM2 relative to that in matched groups with EHT and normal blood pressure (NT).

Methods and Results--In 68 closely matched subjects with EHT+DM2 (n=17), DM2 (n=17), EHT (n=17), and NT (n=17), we measured resting muscle sympathetic nerve activity as the mean frequency of multiunit bursts (MSNA) and of single units (s-MSNA) with defined vasoconstrictor properties. The s-MSNA in EHT+DM2 (97±3.8 impulses/100 beats) was greater (at least P<0.001) than in EHT (69±3.4 impulses/100 beats) and DM2 (78±4.1 impulses/100 beats), and all these were significantly greater (at least P<0.01) than in NT (53±3.3 impulses/100 beats) despite similar age and body mass index. The MSNA followed a similar trend. In addition, the level of insulin was also raised in EHT+DM2 (20.4±3.6 µU/mL) and DM2 (18.1±3.1 µU/mL; at least P<0.05) compared with HT or NT.

Conclusions--Patients with EHT+DM2, EHT, or DM2 had central sympathetic hyperactivity, although plasma insulin levels were raised only in EHT+DM2 and DM2. The combination of EHT and DM2 resulted in the greatest sympathetic hyperactivity and level of plasma insulin, and this hyperactivity could constitute a mechanism for the increased risks of this condition.

Key words: nervous system, sympathetic • hypertension • diabetes mellitus

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