Clinical evaluation of arterial baroreflex activity in diabetes

The clinical and prognostic relevance of the evaluation of the arterial baroreflex is now firmly established in clinical cardiology, where a number of important studies have shown that impairment of arterial baroreflex has independent adverse prognostic value. The results, applied to diabetes, have generated a new perspective in our understanding of autonomic neuropathy. Available data indicate that in diabetes, with or without overt autonomic neuropathy, a widespread abnormality in the baroreflex function is a common finding. This abnormality is evident not only at the cardiac level, but also at the vascular level, by using new techniques able to provide more complete information on the direct baroreflex modulation of the resistance vessels. The question of whether this abnormality is already the consequence of neural damage or only the consequence of a functional involvement remains unsettled, although animal studies and the presence of widespread baroreflex abnormalities even in asymptomatic subjects tend to support the view that baroreceptor function can be altered due to functional and, later, structural damages of efferent nerves, involving both branches of the autonomic nervous system.