Relationship between glycemic control and orthostatic hypotension in type 2 diabetes mellitus — a survey by the Fukuoka Diabetes Clinic Group

Tsutsu, Nobutaka; Nunoi, Kiyohide; Yokomizo, Yuki; Kikuchi, Masanori; Fujishima, Masatoshi

doi:10.1016/0168-8227(90)90021-k

Cited by 18 publications

(19 citation statements)

References 11 publications

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“…This finding may be related to the fact that a decreased cardiovagal tone already existed in prediabetic subjects (13), resulting in an underestimated association between orthostatic hypotension and cardiovagal response to standing. In our diabetic subjects, the plasma A1C level was a factor positively associated with orthostatic hypotension, and other studies have also revealed that diabetic subjects with increased A1C levels are vulnerable to development of orthostatic hypotension (3,6,9) and that glycemic control is critical in the prevention of orthostatic hypotension in such subjects (3,6,9). In contrast, the A1C level was not related to orthostatic hypotension in prediabetic subjects and those with NGT after adjustment for other confounding factors.…”

Section: Discussionmentioning

confidence: 41%

“…Orthostatic hypotension is one clinical manifestation of diabetic autonomic neuropathy (1) and is also a significant risk factor for fall, syncope, cardiovascular disease, and allcause morality (1)(2)(3)(4). Recently, prediabetes has been suggested to produce a significant increase in all-cause mortality and combined diabetes and cardiovascular disease mortality risks (5).…”

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confidence: 99%

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Population-Based Study on the Prevalence and Risk Factors of Orthostatic Hypotension in Subjects With Pre-Diabetes and Diabetes

Yang

et al. 2009

Diabetes Care

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OBJECTIVE -The aim of this study was to investigate the relationship between pre-diabetes and orthostatic hypotension and to examine the prevalence and correlates of orthostatic hypotension in community dwellers with normal glucose tolerance (NGT), pre-diabetes, and diabetes.RESEARCH DESIGN AND METHODS -All participants were classified as having NGT (n ϭ 1,069), pre-diabetes (n ϭ 412), or diabetes (n ϭ 157). Orthostatic hypotension was defined as a decline in systolic/diastolic blood pressure of Ն20/10 mmHg when an individual changed from a supine to a standing position. The cardiovagal response to standing was the ratio between the longest RR interval around beat 30 and the shortest RR interval around beat 15 after standing (30 max-to-15 min ratio).RESULTS -The prevalences of orthostatic hypotension were 13.8, 17.7, and 25.5% in subjects with NGT, pre-diabetes, and diabetes, respectively. For all subjects, age, diabetes, hypertension, and a decreased 30 max-to-15 min ratio, but not pre-diabetes, were independently associated with orthostatic hypotension. Age, hypertension, and 30 max-to-15 min ratio were the correlates of orthostatic hypotension in NGT subjects. Age and hypertension were related to orthostatic hypotension in pre-diabetic subjects. A1C and hypertension were the determinants of orthostatic hypotension in diabetic subjects. Supine blood pressure was related to orthostatic hypotension in all subjects and subgroups.CONCLUSIONS -Pre-diabetic subjects do not have a higher risk of orthostatic hypotension than subjects with NGT, although the risk of orthostatic hypotension is higher in diabetic subjects. Hypertension and supine blood pressure were risk factors for orthostatic hypotension in both pre-diabetic and diabetic subjects. Age and A1C were the correlates of orthostatic hypotension in pre-diabetic and diabetic subjects, respectively. The cardiovagal response to standing is an important determinant of orthostatic hypotension in subjects with NGT but not in pre-diabetic and diabetic subjects. Diabetes Care 32:69-74, 2009

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Section: Discussionmentioning

confidence: 41%

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confidence: 99%

Population-Based Study on the Prevalence and Risk Factors of Orthostatic Hypotension in Subjects With Pre-Diabetes and Diabetes

Yang

et al. 2009

Diabetes Care

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“…Glycosylated hemoglobin levels were found to be higher in diabetic patients with OH than in those without OH, and vagal dysfunction has been suggested in obese diabetic patients. 5,6 However, our patient did not have other symptoms of autonomic failure, and her hyperglycemia, which she had had for 8 years, resolved while she lost weight. Another possibility that was considered was a Guillian-Barré-like syndrome with incomplete autonomic involvement following a viral illness.…”

Section: Commentmentioning

confidence: 86%

Severe Orthostatic Hypotension Following Weight Reduction Surgery

Rubinshtein¹,

Ciubotaru²,

Elad³

et al. 2001

Arch Intern Med

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Surgical interventions for morbid obesity are common practice in many countries, especially when other treatment options have failed or when rapid weight loss is desired. The association between weight and blood pressure is well established, especially the paradigm of obesity-related hypertension. We describe a 45-year-old obese woman with a medical history of hypertension and type 2 diabetes mellitus who lost 57 kg within a few months after a weight reduction surgery. She suffered from severe orthostatic hypotension, which probably resulted from sympathetic nervous system dysfunction. Our patient's clinical status improved with pharmacological interventions, but her symptoms resolved completely after she gained weight following a surgical reversal of the gastric partitioning owing to a local complication. Autonomic nervous system activity does change with the changes in body weight, but after evaluation of this patient, we believe that rapid weight loss may impair sympathetic function and blood pressure control. Although losing weight is a known treatment option for hypertension, exaggerated reversal of obesity-related hypertension might result in orthostatic hypotension.

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“…Most likely, the discrepancy is explained by the inclusion of subjects in advanced age (75-96 years) in the new control material; in our previous study only subjects aged 16 to 59 years were examined. In reports of orthostatic blood pressure after active standing, age was not considered as a confounding factor [2][3][4][5]. Recently it was shown, however, that orthostatic blood pressure after active standing actually is influenced by age to a larger degree than after passive tilt [16].…”

Section: Discussionmentioning

confidence: 98%

“…On the other hand, about 10% of diabetic patients have abnormal systolic orthostatic blood pressure [2][3][4][5]. Orthostatic hypotension is supposed to be a feature of diabetic autonomic neuropathy [6], but few studies have related autonomic nerve function to orthostatic blood pressure [4].…”

Section: Introductionmentioning

confidence: 99%

A prospective study of orthostatic blood pressure in diabetic patients

Kanter

Lilja

Elmståhl

et al. 1998

Clinical Autonomic Research

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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.

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Relationship between glycemic control and orthostatic hypotension in type 2 diabetes mellitus — a survey by the Fukuoka Diabetes Clinic Group

Cited by 18 publications

References 11 publications

Population-Based Study on the Prevalence and Risk Factors of Orthostatic Hypotension in Subjects With Pre-Diabetes and Diabetes

Population-Based Study on the Prevalence and Risk Factors of Orthostatic Hypotension in Subjects With Pre-Diabetes and Diabetes

Severe Orthostatic Hypotension Following Weight Reduction Surgery

A prospective study of orthostatic blood pressure in diabetic patients

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