Co-Existence of hypertension worsens post-exercise cardiac autonomic recovery in type 2 diabetes

Background: Cardiac autonomic neuropathy (CAN) is a commonly overlooked complication of Type 2 Diabetes Mellitus (T2DM) characterized by imbalance between sympathetic and parasympathetic supply to the heart. The susceptibility of heart to dysrhythmias and fatal events increases during and after exercise due to a shift in autonomic regulation. Diabetes and hypertension (HTN) frequently occur concurrently and both conditions lead to impaired cardiac autonomic control. However, their impact together on post-exercise autonomic recovery remains to be explored. Objective: The objective of the study was to investigate the effect of co-existence of HTN on cardiac autonomic recovery (assessed by heart rate recovery and heart rate variability) in patients with T2DM. Methods: Forty eight type 2 diabetic patients (24 normotensive, 24 hypertensive), 24 non-diabetic patients with essential HTN, and 27 healthy controls, were recruited into the study and assessed for heart rate recovery (HRR) following a graded maximal test. Also, heart rate variability (HRV) was recorded before and following the bout of maximal exercise. Results: Heart rate recovery at 1 (HRR1min) and 2 (HRR2min) minute(s) showed significant effects for DM (p < 0.001) and HTN (p < 0.001), while DM × HTN interaction was found to be non-significant. Resting HRV showed a significant decline in time-domain variables for the DM group (p < 0.01). Recovery of HRV showed a significant effect of time (p < 0.05) for all indices, the group effect was found significant only for time-domain measures (p < 0.05). Conclusion: Both HRR and HRV recovery were impaired in DM and HTN. Moreover, the co-existence of HTN had a synergistic effect, causing further worsening of autonomic recovery in T2DM. Keywords: Heart rate recovery, Heart rate variability, Autonomic function, Cardiac autonomic dysfunctio