Blood Pressure Variability and Neuroplasticity in Patients with Type 2 Diabetes Mellitus

摘要

Objective: to analyze the role of blood pressure (BP) in forming neuroplasticity in patients with type 2 diabetes mellitus (DM). Materials and methods. A total of 100 patients with type 2 DM were studied; patients were divided into groups depending on the presence of cognitive impairments (CI), while the control group consisted 25 subjects. All participants underwent clinical examination, a standard set of biochemical blood tests, assay of plasma osteopontin, daily blood pressure monitoring (DBPM) and brain MRI scans (dynamic contrast, arterial spin labeling, proton spectroscopy, tractography). Results. Patients with type 2 DM and CI were found to have higher body mass index, blood glycated hemoglobin, glucose, alanine aminotransferase, low-density lipoprotein, triglycerides, total cholesterol and osteopontin, along with decreased high-density lipoprotein levels (p ≤ 005). The osteopontin level was greater in patients with excess weight, hyperglycemia, dyslipidemia and patients with CI and high BP variability. Assessment of DBPM demonstrated significant differences in terms of all standard indicators, patients with DM type 2 being “non-dippers;” the presence of CI was associated with significantly higher time and area indexes for the stay in the suprathreshold BP stage and nocturnal SBP and DBP, as well as with the risk of occult hypertension. Decreased brain blood flow was seen in data on assessment of perfusion in the cortical (especially the frontal lobe) and subcortical (mainly the putamen) structures, and was associated with changes in DBPM parameters. Mean SBP and DBP in the day and night, as well as the index of BP variability, also influenced the integrity of the corticospinal, uncinate and inferior longitudinal tracts and the arcuate fasciculus. These parameters altered hippocampal metabolism in terms of choline (Cho), creatine (Cr), creatine phosphate (Cr2) and the ratios acetylaspartate (NAA)/Cho, NAA/Cr, and Cho/Cr. Conclusions. BP variability in patients with type 2 DM contributed to forming CI by a proinflammatory mechanism leading to impairments of vascularization of the brain in general and white matter structure and hippocampal metabolism.