A prospective study of orthostatic blood pressure in diabetic patients

Abstract

To clarify whether orthostatic blood pressure is affected by the type of diabetes, cardiac autonomic neuropathy, and the duration of diabetes, orthostatic blood pressure (passive 90 degrees tilt) was evaluated in 102 patients with insulin dependent diabetes mellitus (IDDM), 51 patients with non-insulin dependent diabetes mellitus (NIDDM), and in 238 control subjects in a first study followed up after 8 to 17 years. The heart rate reaction during deep breathing (E/I ratio) and to tilt (acceleration and brake indices) assessed cardiac autonomic function. In the first study, the lowest systolic blood pressure (LSBP) and the lowest diastolic blood pressure (LDBP) after tilt were significantly lower in IDDM patients compared with NIDDM patients (p < 0.001 for LSBP and p < 0.05 for LDBP) and controls (p < 0.001). LDBP was, however, also significantly lower (p < 0.05) in NIDDM patients than in controls. Hence, although most severe in IDDM, LDBP was disturbed in both types of diabetes. In IDDM, a low E/I ratio was associated with disturbed orthostatic blood pressure. At follow-up examinations, orthostatic blood pressure deteriorated in NIDDM but not in IDDM patients. In conclusion, LSBP and LDBP were impaired in IDDM patients compared with NIDDM and control subjects; however, LDBP was also impaired in NIDDM patients compared with controls. When the duration of diabetes increased, orthostatic blood pressure deteriorated in NIDDM but not in IDDM patients.

Impaired cardiovagal and vasomotor responses to baroreceptor stimulation in type II diabetes mellitus

“…Measurable signs of autonomic nervous system dysfunction develop in up to 30% of diabetic patients after 10-15 years [1]. Clinical manifestations of diabetic autonomic neuropathy include pupillary dysfunction [2,3], alimentary tract disorders [4], impaired sweating [5], genitourinary disturbances [6,7] and cardiovascular dysregulation [8][9][10][11][12][13].…”

Impaired Gastric Emptying in Primary Sjögren’s Syndrome

“…individuals (22 women, median age 40 yrs, range 16-59 yrs), all of whom had passed a health examination without signs of cardiovascular disease, respiratory disorders, or diabetes mellitus 17 . The controls for the orthostatic blood pressure reaction test consisted of 238 healthy nondiabetic individuals (106 women, median age 60 yrs, range 16-96 yrs) 18 . The finger skin blood flow test controls were 80 healthy subjects (37 women, median age 43 yrs, range 19-81 yrs), all nonsmokers with no history of vascular disease, and were not taking any medication 19 .…”

Assessment of autonomic symptoms in diabetics: the Swedish version of the Autonomic Symptom Profile

“…According to previous studies this reflects the sympathetic nervous function in the skin (Bornmyr et al, 1998). The autonomic nervous function variables were age corrected and expressed as z-scores by comparison with three control groups which have previously been described in detail (Bergström et al, 1986;Bornmyr et al, 1998;de Kanter et al, 1998).…”