Endocrinology and metabolism (including diabetes, hormones)
Clinical medicine
Cardiovascular autonomic neuropathy (CAN) is a frequent complication of diabetes mellitus
and is associated with increased morbidity and mortality in patients with diabetes.
Hence, early and correct diagnosis of CAN is crucial. Standard cardiovascular reflex
rests (CARTs) have been the gold standard of CAN assessment. Originally, CARTs consisted
of five reflex tests, but measuring diastolic blood pressure response to sustained
handgrip exercise has no longer been suggested as an established clinical test. Increasing
body of evidence suggests that isometric handgrip test should no longer be used for
the evaluation of sympathetic dysfunction during cardiovascular autonomic neuropathy
assessment in diabetic patients. The associations of isometric handgrip test results
with parameters of hypertension and markers of hypertension-related target-organ damage
in diabetic and non-diabetic individuals point toward its potential role as a screening
tool to identify patients with high cardiovascular risk. The current review summarizes
historical view of standard cardiovascular reflex tests and latest data on isometric
handgrip test.
