Efficacy of Administration of an Angiotensin Converting Enzyme Inhibitor for Two Years on Autonomic and Peripheral Neuropathy in Patients with Diabetes Mellitus

• Published in: Journal of Diabetes Research Vol. 2017; no. 2017; pp. 1 - 6
• Main Authors: Hatzitolios, Apostolos I., Mourouglakis, Alexandros, Tsotoulidis, Stefanos, Stergiou, Ioannis, Kontoninas, Zisis, Margaritidis, Charalambos, Tziomalos, Konstantinos, Didangelos, T., Karlafti, Eleni
• Format: Journal Article
• Language: English
• Published: Cairo, Egypt Hindawi Publishing Corporation 01.01.2017; Hindawi; John Wiley & Sons, Inc; Hindawi Limited; Wiley
• Subjects: ACE inhibitors; Adult; Aged; Analysis; Angiotensin-Converting Enzyme Inhibitors - administration & dosage; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Autonomic Nervous System - drug effects; Autonomic Nervous System - physiopathology; Blood pressure; Cardiovascular disease; Cholesterol; Clinical Study; Complications and side effects; Diabetes; Diabetes Complications - drug therapy; Diabetes Mellitus, Type 1 - drug therapy; Diabetic neuropathy; Diabetic retinopathy; Diagnostic tests; Dosage and administration; Drug therapy; Enzymes; Female; Humans; Hypotension; Hypotension, Orthostatic; Male; Metabolism; Middle Aged; Mortality; Peripheral Nervous System Diseases - drug therapy; Peripheral neuropathy; Polyneuropathies; Postural Balance - drug effects; Quinapril; Risk factors; Surveys and Questionnaires; Tetrahydroisoquinolines - administration & dosage; Tetrahydroisoquinolines - therapeutic use; Treatment outcome; Vibration; Young Adult; United States > US; Michigan
• ISSN: 2314-6745; 2314-6753
• DOI: 10.1155/2017/6719239

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.