DIABETIC AUTONOMIC NEUROPATHY - CONVENTIONAL CARDIOVASCULAR LABORATORY TESTING AND NEW DEVELOPMENTS

Cardiovascular reflex tests remain the investigational cornerstone for the assessment of patients in the clinical autonomic laboratory. Thre e cardiovagal tests have been found suitable for testing: the instanta neous heart rate responses induced by deep breathing, Valsalva's manoe uvre and standing up. Suitable laboratory indices of adrenergic functi on include continuous monitoring of blood pressure responses induced b y Valsalva's manoeuvre and standing up, which is now possible through tracking of beat-to-beat blood pressure changes at the finger. Spectra l analysis of heart rate and blood pressure and pulse wave analysis fo r stroke volume changes are promising approaches to evaluate abnormali ties in arterial baroreflex regulatory mechanisms in diabetic patients .