Hypertension Contributes to Neuropathy in Patients With Type 1 Diabetes

• Published in: American journal of hypertension Vol. 32; no. 8; pp. 796 - 803
• Main Authors: Ponirakis, Georgios, Petropoulos, Ioannis N, Alam, Uazman, Ferdousi, Maryam, Asghar, Omar, Marshall, Andrew, Azmi, Shazli, Jeziorska, Maria, Mahfoud, Ziyad R, Boulton, Andrew J M, Efron, Nathan, Nukada, Hitoshi, Malik, Rayaz A
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 17.07.2019
• Subjects: Original Contributions; blood pressure; diabetic peripheral neuropathy; hypertension; nerve conduction; quantitative sensory testing; corneal confocal microscopy
• ISSN: 0895-7061; 1879-1905; 1941-7225
• DOI: 10.1093/ajh/hpz058

Diabetic peripheral neuropathy (DPN) can lead to foot ulceration and amputation. There are currently no disease-modifying therapies for DPN. The aim of this study was to determine if hypertension contributes to DPN in patients with type 1 diabetes mellitus (T1DM). Subjects with T1DM (n = 70) and controls (n = 78) underwent a comprehensive assessment of DPN. Hypertension was present in 40 of 70 T1DM subjects and 20 of 78 controls. Hypertension was associated with abnormal nerve conduction parameters (P = 0.03 to <0.001), increased vibration perception threshold (P = 0.01) and reduced corneal nerve fiber density and length (P = 0.02) in subjects with T1DM. However, after adjusting for confounding factors only tibial compound motor action potential and nerve conduction velocity were associated with hypertension (P = 0.03) and systolic blood pressure (P < 0.01 to <0.0001). Hypertension had no effect on neuropathy in subjects without diabetes. This study shows that hypertension is associated with impaired nerve conduction in T1DM. It supports previous small trials showing that angiotensin-converting enzyme inhibitors improve nerve conduction and advocates the need for larger clinical trials with blood pressure lowering agents in DPN.