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OBJECTIVE: To assess arterial stiffness in pregnancies complicated by hypertensive disorders: preeclampsia and chronic hypertension. STUDY DESIGN: Twenty preeclamptic and 18 chronic hypertensive parturients were studied. The reference data were obtained from 29 healthy pregnant women and 29 non-pregnant women. Systolic blood pressure (SAP), diastolic blood pressure (DAP), mean arterial pressure (MAP) and pulse pressure (PP) were measured. Stroke index (SI), heart rate (HR), cardiac index (CI), systemic vascular resistance index (SVRI) and pulse wave velocity (PWV) were derived by whole-body impedance cardiography. Arterial compliance was defined as the SI to PP ratio (SI/PP). RESULTS: Significantly higher PP and PWV and lower SI/PP were observed in preeclamptic compared to uncomplicated pregnancies. Preeclamptic pregnancies also differed from chronic hypertensive pregnancies by higher PP and lower SI/PP. Women with chronic hypertension had significantly higher PWV than the control group, but PP and SI/PP were not different. In both hypertensive groups SVRI was exceptionally high. CONCLUSIONS: Besides the vasoconstriction of smaller peripheral arteries, our finding of increased arterial stiffness in preeclamptic pregnancies suggests that also larger arteries with altered viscoelastic properties are involved in the aberrant hemodynamics of preeclampsia. Compared to preeclamptic subjects, women with chronic hypertension shared a common feature of high systemic vascular resistance, but changes in arterial stiffness were less than in preeclampsia.
BACKGROUND: The purpose of the Finnish Cardiovascular Study (FINCAVAS) is to construct a risk profile--using genetic, haemodynamic and electrocardiographic (ECG) markers--of individuals at high risk of cardiovascular diseases, events and deaths. METHODS AND DESIGN: All patients scheduled for an exercise stress test at Tampere University Hospital and willing to participate have been and will be recruited between October 2001 and December 2007. The final number of participants is estimated to reach 5,000. Technically successful data on exercise tests using a bicycle ergometer have been collected of 2,212 patients (1,400 men and 812 women) by the end of 2004. In addition to repeated measurement of heart rate and blood pressure, digital high-resolution ECG at 500 Hz is recorded continuously during the entire exercise test, including the resting and recovery phases. About 20% of the patients are examined with coronary angiography. Genetic variations known or suspected to alter cardiovascular function or pathophysiology are analysed to elucidate the effects and interactions of these candidate genes, exercise and commonly used cardiovascular medications. DISCUSSION: FINCAVAS compiles an extensive set of data on patient history, genetic variation, cardiovascular parameters, ECG markers as well as follow-up data on clinical events, hospitalisations and deaths. The data enables the development of new diagnostic and prognostic tools as well as assessments of the importance of existing markers.
BACKGROUND: Nicotinamide adenine dinucleotide phosphate (NADPH) oxidase is a major source of the superoxide anion, which may play an important role in the development of atherosclerosis and coronary artery disease (CAD). The p22phox, a component of the NADPH oxidase, is essential for the activation of this enzyme, and intensive expression of the p22phox has been reported in human atherosclerotic arteries. However, studies on the association of the C242T polymorphism in the p22phox gene with CAD have produced conflicting results, and the relation of this polymorphism with CAD is not well known in a population with acquired risk factors enhancing the NADPH-dependent superoxide production. METHODS: As part of the Finnish Cardiovascular Study, a case-control study was conducted with 402 high-risk Finnish Caucasian patients undergoing coronary angiography. Genotyping was performed using the 5' nuclease TaqMan assay. RESULTS: The prevalence of the T allele (TT + TC genotypes) was significantly lower among angiographically verified CAD patients (n = 250) than among control subjects (n = 152, P = .013). In contrast to subjects with the CC genotype, the T allele was found protective against CAD (odds ratio = 0.531, 95% CI 0.331-0.852, P = .009), and the results remained significant after adjustment for other significant coronary risk factors. CONCLUSIONS: The T allele in the C242Tpolymorphism of the p22phox gene had a protective effect against the development of CAD despite the exposure of study subjects to risk factors related to excessive NADPH-dependent superoxide production.
PURPOSE: We measured the detailed hemodynamic effects of tamsulosin and sildenafil separately and together in patients with benign prostatic enlargement. MATERIALS AND METHODS: The supine effects of and responses to passive orthostasis (60 degrees for 8 minutes) were measured in 16 patients with benign prostatic enlargement with the finger blood pressure method and whole-body impedance cardiography. The medications, 100 mg sildenafil (single doses) and 0.4 mg tamsulosin (once daily for up to 14 days), were administered in a randomized, double-blind, crossover fashion. RESULTS: Supine systolic arterial pressure decreased with sildenafil (mean +/- SEM -11 +/- 2 mm Hg) and sildenafil plus tamsulosin (-14 +/- 2 mm Hg) more than with placebo (-2 +/- 4 mm Hg, p <0.05). In comparison to placebo sildenafil plus tamsulosin decreased the systemic vascular resistance index (328 +/- 129 vs -241 +/- 134 dyn.sec/cm.m, p = 0.01). Tamsulosin alone did not cause any significant changes in comparison to placebo. Heart rate, diastolic arterial pressure, stroke index, cardiac index and arterial pulse wave velocity were not affected to a statistically significant degree by any of the treatments compared to placebo. Upon head-up tilt the drugs caused only 1 significant change in that diastolic arterial pressure was significantly higher (-2.7 vs -8.0 mm Hg, p = 0.04) in the placebo group than in the tamsulosin plus sildenafil group. CONCLUSIONS: Tamsulosin does not disturb hemodynamics in patients with benign prostatic enlargement. Sildenafil decreases blood pressure with the patient supine but not during head-up tilt. The combination treatment also decreases the systemic vascular resistance index in the supine position.
The goal of this study was to evaluate the role of asymmetric dimethylarginine (ADMA) in the regulation of hemodynamic functions in hypertensive men. It has been suggested that ADMA, as an endogenous nitric oxide synthase inhibitor, is linked to hypertension and vascular reactivity. Sixty-seven men aged 51.1 years (range, 45-55 years) were studied. Plasma ADMA and symmetric dimethylarginine were determined by high-performance liquid chromatography-tandem mass spectrometry. Blood pressure (BP) was measured by 24-hour ambulatory recordings and casual measurements. Hemodynamic regulation was assessed by noninvasive methods. The nitric oxide production was estimated based on plasma nitrate (NO(3)(-)) determination. Results showed that plasma arginine derivatives or l-arginine/ADMA ratio was not associated with BP values observed during 24-hour monitoring or in casual measurements. Systemic vascular resistance, pulse wave velocity, or cardiac output was not associated with plasma ADMA or plasma NO(3)(-) levels. No association was found between plasma ADMA and NO(3)(-) either. Interestingly, subjects on antihypertensive treatment had lower plasma ADMA concentrations than nontreated subjects (0.30+/-0.08 and 0.36+/-0.11 micromol/L, respectively, P=.04) despite higher BP values. In conclusion, these results suggest that plasma ADMA does not have a determinative role in the regulation of hemodynamic functions in Finnish middle-aged men.
We describe pronounced hypotension in a patient during orthostatic testing while receiving treatment with sildenafil and tamsulosin, but not with placebo. The patient was 71 years of age and had no history of orthostatic reactions. He had been diagnosed with benign prostatic hyperplasia (BPH) and glaucoma simplex (open-angle glaucoma). The only regular medication used was a combination of latanoprost and timolol one drop daily into each eye. The patient was among 16 men with BPH enrolled in a study of the haemodynamic effects of tamsulosin and sildenafil. The present patient was excluded from data analysis because of atypical reactions: he experienced a decrease in peripheral vascular resistance upon orthostasis during treatment with sildenafil and tamsulosin. This led to marked hypotension and cancellation of the tilt tests with both sildenafil alone (Riva-Rocci [RR] 75/50 mm Hg) and a combination of sildenafil and tamsulosin (RR 60/45 mm Hg); however, tamsulosin alone also lowered blood pressure to some extent (RR 100/80 mm Hg). In conclusion, even though sildenafil and tamsulosin are considered haemodynamically safe, they may induce considerable vasodilation and, subsequently, harmful hypotension in susceptible patients.
We tested whether the Arg389Gly and Ser49Gly polymorphisms of the beta1-adrenergic receptor gene ADRB1 and the T393C polymorphism of the G protein alpha-subunit gene GNAS1 modulate heart rate (HR) and blood pressure responses during an exercise stress test. The study population comprised 890 participants (563 men and 327 women, mean age 58.1 +/- 12.6 yr) of the Finnish Cardiovascular Study. Their HR, systolic (SAP), and diastolic arterial pressures (DAP) at rest, during exercise, and 4 min after the test were measured and analyzed by repeated-measurement ANOVA (RANOVA). Genotypes were detected by TaqMan 5' nuclease assay. In all subjects, and in men and women separately, the T393C of GNAS1 was the only polymorphism with genotype x time interaction in HR over the three study phases (P = 0.04, RANOVA). None of the polymorphisms presented genotype x time interaction in SAP or DAP responses (P > 0.10, RANOVA). In all subjects at rest, the Ser49Gly polymorphism of ADRB1 tended (P = 0.06, ANOVA) to differentiate HR. Arg389Gly polymorphism of ADRB1 affected maximal SAP during exercise (P = 0.04, ANOVA) and the change in SAP from rest to maximal (P = 0.03, ANOVA). Arg389 homozygotes, particularly men, were less likely to have ventricular extrasystoles during the exercise (odds ratio = 0.68, 95% confidence interval = 0.51-0.91, P = 0.009, and odds ratio = 0.60, 95% confidence interval = 0.42-0.86, P = 0.006, respectively) than did Gly389 carriers. In conclusion, polymorphisms examined appear to have modulatory effects on hemodynamics in a clinical exercise test setting. However, the effects in absolute numbers were minor and clinically possibly insignificant.
OBJECTIVE: The purpose of this study was to evaluate serum triiodothyronine levels as a trigger of postoperative atrial fibrillation (AF) in elderly patients undergoing cardiac surgery and to study the possible association of serum triiodothyronine levels with preoperative and postoperative hemodynamics. DESIGN: Prospective study. SETTING: University hospital. PARTICIPANTS: Forty-six consecutive nonemergency patients 65 years or older undergoing cardiac surgery during 1999 to 2000 in Tampere University Hospital, Tampere, Finland. INTERVENTIONS: Free serum T3 concentration was used as a measure of serum triiodothyronine levels. Samples were taken preoperatively, on the fourth postoperative day, and at the 3-month follow-up. The hemodynamic state of the patients was estimated by whole-body impedance cardiography preoperatively, during the intensive care unit period, daily until the fourth postoperative day, and at the 3-month follow-up. MEASUREMENTS AND MAIN RESULTS: AF occurred in 43% of the patients. The patients in the AF group had significantly more grafts (3.9 v 3.1, p = 0.02), and there was a small difference in age between the AF and non-AF groups (73 years v 69 years, p = 0.06). The free T3 concentration on the fourth postoperative day was significantly lower in the AF group (3.5 nmol/L v 4.6 nmol/L, p = 0.04). In logistic regression analysis, the independent predictors of AF were age, number of grafts, and serum free T3 concentration on the fourth postoperative day. In the group with low T3 concentration, the cardiac index was lower (1.4 v 1.8, p = 0.05) and the systemic vascular resistance index was higher (4,064 v 2,969, p = 0.04) but only immediately after the operation. Although the AF mostly appeared during the second to fourth postoperative days, there were no longer any differences in the hemodynamic state at that time. CONCLUSIONS: In a group of elderly patients undergoing cardiac surgery, there was a strong association between a postoperative decrease of serum triiodothyronine levels and atrial fibrillation. The decrease of serum triiodothyronine levels was related to the changes of hemodynamic parameters only in the immediate postoperative period.
OBJECTIVE: The aim of this study was to compare the influences of antianginal drugs such as mononitrate, beta-blocker and calcium channel blocker on cardiovascular responsiveness to orthostasis. METHODS: The responses to passive orthostasis (tilt provocation at 60 degrees for 3 min) were measured in normotensive healthy volunteers with whole-body impedance cardiography and finger blood-pressure monitoring after a single moderate oral dose of isosorbide-5-mononitrate (CAS 16051-77-7, 10 mg), the beta1-blocker bisoprolol fumarate (CAS 104344-23-2, 5 mg), the dihydropyridine calcium channel blocker nisoldipine (CAS 63675-72-9, 5 mg), and placebo in a randomised, double-blind fashion. RESULTS: In supine position, none of the drugs altered pre-tilt arterial pressure or heart rate (HR) when compared to placebo. Nisoldipine decreased systemic vascular resistance index (SVRI) when compared to either placebo or bisoprolol, and increased the cardiac index (CI) when compared to placebo. During the passive orthostasis, the mononitrate decreased SVRI when compared to placebo or bisoprolol. The mononitrate increased HR and pulse wave velocity (PWV) when compared to the other study groups, and decreased the stroke index when compared to placebo. In the bisoprolol group, the tilt responses of diastolic arterial pressure, HR, CI, left cardiac work index, and PWV decreased significantly compared to those in the placebo group. Nisoldipine did not alter the responses to orthostasis when compared to placebo. When compared to the mononitrate, both nisoldipine and bisoprolol decreased CI response to orthostasis. CONCLUSIONS: The mononitrate adversely affects the cardiovascular responsiveness to orthostasis. The beta-blocker reduces the responses and thus probably oxygen demand during orthostasis. The dihydropyridine calcium blocker seems to influence the responsiveness less than the mononitrate or beta-blocker.
OBJECTIVE: To compare the acute effects of the beta-blocker propranolol (CAS 525-66-6), beta + alpha1-blocker carvedilol (CAS 72956-09-3) and alpha1-blocker tamsulosin (CAS 106463-17-6) on the cardiovascular responses to passive orthostasis. METHODS: The responses to passive orthostasis (tilt provocation at 60 degress for 8 min) were measured in normotensive healthy volunteers with finger-blood-pressure and whole-body impedance cardiography prior to drugs and three days after beginning the medications. The treatments were moderate oral doses of the beta-blocker propranolol HCl (40 mg twice daily, n = 7), (beta + alpha1-blocker carvedilol (12.5 mg once daily for two days and thereafter 25 mg daily, n = 7), alpha1-blocker tamsulosin HCl (0.4 mg once daily, n = 6), or placebo. The drugs were distributed in a randomised, double-blind fashion. RESULTS: When measured prior to the head-up tilt test, propranolol and carvedilol had decreased supine systolic arterial pressure (SAP) more than placebo, and heart rate (HR) more than placebo and tamsulosin. Propranolol had decreased also pulse wave velocity more than placebo. The cardiac index (CI), stroke index (SI) and systemic vascular resistance index (SVRI) were not changed with any drugs. During the head-up tilt, tamsulosin decreased SAP and SVRI and augmented CI but not SI. The SVRI response curve with tamsulosin differed from that with propranolol or carvedilol. Also, tamsulosin increased HR compared to the beta-blocking drugs. The propranolol and carvedilol groups did not differ from each other in terms of any parameter. CONCLUSIONS: Tamsulosin significantly decreases SAP in the passive head-up tilt, indicating that it is not purely uroselective alpha1-blocker. The responses with tamsulosin clearly differ from those with propranolol and carvedilol, the responses with the latter two being practically equal.
BACKGROUND: This descriptive study was designed to evaluate maternal hemodynamics and cardiovascular responses to delivery during cesarean section (CS) under spinal anesthesia. We also assessed the feasibility of a noninvasive and continuous method of measuring cardiac output, namely whole-body impedance cardiography (ICG(WB)), during elective CS. Because of the techniques used in previous studies, only fractionated data on maternal hemodynamics during CS are available to date. METHODS: We studied 10 healthy women with normal pregnancies and two pregnant women with heart disease undergoing elective CS. Mean arterial pressure (MAP), heart rate (HR), stroke index (SI), cardiac index (CI) and systemic vascular resistance index (SVRI) were recorded continuously during CS, during the period of dissipation of anesthesia and on the second to fifth postpartum day. Analysis of variance for repeated measurements (anova) and the paired sample t-test were used in statistical analysis. RESULTS: The hemodynamic parameters could be registered continuously during the whole procedure. At the point of delivery, a 47% increase in CI and a 39% decrease in SVRI were recorded, while MAP remained stable. These changes occurred within 2 min of delivery of the newborn and persisted on average for 10 min. CONCLUSION: Sudden and significant hemodynamic changes take place at the moment of delivery. Intact physiological cardiovascular compensation mechanisms are needed to adapt to these challenges. Whole-body impedance cardiography may offer a useful noninvasive tool to monitor hemodynamics during cesarean section.
OBJECTIVE: To compare in details the effects of urologically used alpha(1)-blockers alfuzosin and tamsulosin on the cardiovascular responses to passive orthostasis. METHODS: The responses to passive orthostasis (tilt provocation at 60 degrees for 8 min) were measured in normotensive healthy volunteers with finger blood pressure method and whole-body impedance cardiography prior to the administration of the drugs as well as three days after the beginning of the randomised, double-blind medications. The parallel treatments were standard clinically used doses of alpha(1)-blockers alfuzosin (5 mg twice daily, n=10), tamsulosin (0.4 mg once daily, n=10), or placebo (n=11). RESULTS: When measured prior to the head-up tilt test in supine position, neither alfuzosin nor tamsulosin significantly changed any of the cardiovascular variables. During the passive orthostasis, however, both tamsulosin and alfuzosin reduced systemic vascular resistance index compared to pre-drug responses (-540 and -462 dyns/cm(5)m(2), respectively, p<0.05). Both drugs also augmented orthostatic responses of heart rate (11 and 9 bpm, respectively, p<0.05) and cardiac index (0.50 and 0.40 l/min/m(2), respectively, p<0.05) but not those of stroke index when compared to the responses during placebo or before the administration of the drugs. The alfuzosin and tamsulosin groups did not significantly differ from each other in terms of any parameter. CONCLUSIONS: Both alfuzosin and tamsulosin have clear cardiovascular effects, which are most strikingly evident in the influences on systemic vascular resistance and cardiac output.
BACKGROUND: Haemodialysis (HD) is associated with acute changes simultaneously in fluid status (ultrafiltration) and in many biochemical parameters (dialysis). Reports on the effects of these changes on left ventricular (LV) diastolic function are scant. This study evaluated the effect of isolated ultrafiltration (UF) and subsequent HD with minimal fluid removal on Doppler-derived indices of LV diastolic function in patients who were asymptomatic and stable on HD. METHODS: In 11 HD cases, the 5 h treatment session was divided into a 2.5 h period of fluid removal without dialysis (UF phase) and 2.5 h of dialysis with minimal fluid removal (HD phase). We examined the following parameters of LV diastolic function echocardiographically: early rapid filling (Emax), atrial peak filling (Amax), Emax/Amax ratio, isovolumic relaxation time (IVRT) and deceleration time of the E-wave (DT). RESULTS: During the UF phase, Emax decreased from 0.82 +/- 0.2 to 0.62 +/- 0.2 m/s (P = 0.003), Amax decreased from 0.72 +/- 0.2 to 0.63 +/- 0.2 m/s (P = 0.042) and the ratio Emax/Amax did not change (P = NS). During the HD phase, Emax increased from 0.62 +/- 0.2 to 0.72 +/- 0.2 m/s (P = 0.018), Amax increased from 0.63 +/- 0.2 to 0.70 +/- 0.3 m/s (P = NS) and the Emax/Amax ratio remained unchanged (P = NS). IVRT was prolonged in 10 out of 11 patients at the start of the UF phase and it was further prolonged from 142 +/- 40 to 171 +/- 55 ms (P = 0.03) during the UF phase. IVRT did not alter during the HD phase (P = NS). During the UF phase, DT increased from 175 +/- 83 to 244 +/- 119 and it decreased from 244+/-119 to 209 +/- 98 in the HD phase, but both changes were statistically insignificant. No statistically significant correlations were observed between the changes in the Doppler indices of diastolic function and changes in biochemical parameters during the HD phase. CONCLUSIONS: UF affects the parameters Emax, Amax and IVRT used to evaluate LV diastolic function. The changes in Emax and Amax during the HD phase are due to fluid refilling from tissues into the blood space, HD as such having no effect on Doppler indices. However, isolated UF or HD does not affect the Emax/Amax ratio. Emax and IVRT seem to be the most volume-sensitive parameters.
The purpose of the study was to estimate the reliability of whole-body impedance cardiography (ICGWB)-derived pulse wave velocity (PWV) and stroke volume index to pulse pressure (SI/PP) measurements. The repeatability and reproducibility of ICGWB parameters were also determined. Agreement between the impedance and Doppler ultrasound-based PWV measurements was estimated in 25 healthy subjects in two consecutive measurements. Impedance-derived SI/PP (SIICG/PP) estimates were compared with simultaneously measured SI/PP based on thermodilution (SITD/PP) and direct Fick (SIFICK/PP) methods in 30 surgical patients. PWV measured between the aortic arch and popliteal artery using the impedance technique with selective electrode configuration (PWVIS) agreed well with the Doppler ultrasound method (PWVDOPP), the bias (PWVDOPP - PWVIS) and precision (+/- SD of differences) being 0.00 and 0.79 m s-1, respectively. PWV derived from the whole-body and popliteal impedance plethysmograms (PWVICG) overestimated slightly PWVDOPP values. The repeatability value for PWVIS was excellent, being 0.54 m s-1. The reproducibility values for PWVDOPP and PWVIS were very similar (2.17 and 2.42 m s-1, respectively). Changes in PWVIS correlated strongly with changes in PWVDOPP (r=0.74; P<0.0001), indicating that both methods reflected the true physiological variation in PWV. The agreement between SIICG/PP and SITD/PP or SIFICK was almost identical to the agreement between the SITD/PP and SIFICK/PP. In conclusion,whole-body impedance cardiography provides handy and reliable means of evaluating arterial stiffness on the basis of PWV and SI/PP simultaneously with conventional haemodynamic parameters. The method is highly repeatable and reproducible.
The aim of this study was to evaluate the utility of whole-body impedance cardiography (ICGWB) in sleep studies, particularly in sleep apnoea detection. A comparison between simultaneous whole night ICGWB and standard polysomnographic recordings were made in 14 patients with a clinical suspicion of obstructive sleep apnoea, a mean age of 46 years (range 30-63 years) and a mean BMI of 29 kg m-2 (25-47). Obstructive apnoeas, central apnoeas and hypopnoeas all caused characteristic patterns in the ICGWB tracing. For an apnoea-hypopnoea index (AHI) > 15 events h-1, the sensitivity of ICGWB was 89% and the specificity 80%. In conclusion, ICGWB signal includes valuable physiological information that can be effectively used for the detection of sleep apnoea episodes. The method seems promising in cases where the multichannel polysomnography is not applicable or when ICGWB is used for haemodynamic monitoring in seriously ill and postoperative patients.
OBJECTIVE: To test the feasibility of continuous cardiac output (CO) monitoring with whole-body impedance cardiography after coronary artery bypass grafting and to compare the values obtained with those measured using the bolus and continuous thermodilution methods. DESIGN: A prospective study. SETTING: Intensive care unit in a university hospital. PATIENTS: Twenty patients after coronary artery bypass grafting. INTERVENTIONS: CO was measured intermittently using the bolus thermodilution method, and continuously using the continuous thermodilution method, and whole-body impedance cardiography immediately after transfer to the intensive care unit. MEASUREMENTS AND MAIN RESULTS: Bolus thermodilution CO was measured in triplicate at up to 14 time points overnight. Continuous thermodilution CO and whole-body impedance cardiography CO values were recorded simultaneously. During the study period, the bias in CO values between bolus thermodilution and whole-body impedance cardiography ranged from 0.07 to 1.05 L/min and the precision (standard deviation of differences) ranged from 0.82 to 1.31 L/min. The bias between the bolus and continuous thermodilution methods ranged from 0.06 to 0.58 L/min and the precision from 0.43 to 1.02 L/min. Pulmonary artery temperature and CO level were the major determinants of the bias and precision in both comparisons. CONCLUSIONS: Agreement between whole-body impedance cardiography and bolus thermodilution is slightly inferior to that between the bolus and continuous thermodilution methods but not to the extent that it hampers the use of whole-body impedance cardiography for the continuous monitoring of CO after coronary artery bypass surgery.
Type 2 diabetes is a strong risk factor for coronary heart disease and sudden cardiac death. It is associated with reduced baroreflex sensitivity (BRS) and heart rate variability (HRV), which are indicators of increased risk for mortality and morbidity in various patient populations. This study was designed to assess the effects of exercise training on BRS, HRV, and hemodynamics in patients with type 2 diabetes. Subjects (50 men, mean age 53.3 +/- 5.1 years) with type 2 diabetes were randomized into either a control group, in which they received conventional treatment only, or an exercise group, in which they received conventional treatment together with heart rate-controlled endurance training twice a week and supervised muscle strength training twice a week for 12 months. Measurements taken at baseline and follow-up included VO(2max), standard time and frequency domain measures of HRV during 24-h recording, and BRS by the phenylephrine method. Cardiac index, systemic vascular resistance index, stroke index, and pulse wave velocity were measured by whole-body impedance cardiography. Significant improvements in VO(2max) (exercise group: +2.3 ml x kg(-1) x min(-1); P < 0.005 vs. control group), muscle strength, and glycemic control (exercise group: HbA(1c) -0.9%; P < 0.001 vs. control group) were observed in the exercise group. BRS increased in the exercise group, from 6.8 to 8.6 ms/mmHg, and decreased in the control group, from 7.5 to 6.4 ms/mmHg (95% CI for the difference between 0.05 and 4.36 ms/mmHg; P < 0.05). No significant changes in the time or frequency domain measures of HRV or in systemic hemodynamics were observed. We concluded that exercise training improves BRS sensitivity in type 2 diabetes subjects in addition to increasing the exercise capacity and muscle strength and improving glucose control. These beneficial effects in reflectory autonomic regulation and glucose control caused by exercise may be associated with improved prognosis of type 2 diabetes patients.