Background: Aim of this study is to investigate a possible association of hypoglycemic episodes and arterial hypertension. We hypothesize that hospitalized insulin-treated diabetes patients with hypertensive crisis have more hypoglycemic episodes than their counterparts without hypertensive crisis on admission.Methods: In a prospective, observational cohort study, 65 insulin-treated diabetes patients (type 1, type 2, type 3c) were included in Group 1, when a hypertensive crisis was present, as control patients in Group 2 without hypertensive crisis or hypoglycemia, in Group 3, when a symptomatic hypoglycemia was present on admission. All patients were subjected to open-label continuous flash glucose monitoring, to 24-hour blood-pressure and Holter electrocardiogram recordings, and to laboratory tests including plasma catecholamines. Results: 53 patients, thereof 19 Group-1, 19 Group-2, 15 Group-3 patients, completed this study. Group-1 patients had the highest maximum systolic blood pressure, a higher daily cumulative insulin dose at admission, a higher body-mass index, and a higher plasma norepinephrine than control patients of Group 2. Group-3 patients had more documented hypoglycemic episodes (0.8 ± 0.5 per 24 hours) than Group-2 patients (0.2 ± 0.3 per 24 hours), however, they were not different to the ones in Group-1 patients (0.4 ± 0.4 per 24 hours). Plasma norepinephrine and mean arterial blood pressure were not different between Group-1 and Group-3 patients, though higher than in Group-2 patients. At discharge, the daily cumulative insulin dose was reduced in Group-1 (-18.4 ± 24.9 units) and Group-3 patients (-18.6 ± 22.7 units), but remained unchanged in Group-2 patients (-2.9 ± 15.6 units).Conclusions: An association between hypoglycemic events and uncontrolled hypertension was found in this study.
Background Aim of this study is to investigate a possible association of hypoglycemic episodes and arterial hypertension. We hypothesize that hospitalized insulin-treated diabetes patients with hypertensive crisis have more hypoglycemic episodes than their counterparts without hypertensive crisis on admission. Methods In a prospective, observational cohort study, 65 insulin-treated diabetes patients (type 1, type 2, type 3c) were included in Group 1, when a hypertensive crisis was present, as control patients in Group 2 without hypertensive crisis or hypoglycemia, in Group 3, when a symptomatic hypoglycemia was present on admission. All patients were subjected to open-label continuous glucose monitoring, 24-h blood-pressure- and Holter electrocardiogram recordings, and to laboratory tests including plasma catecholamines. Results 53 patients, thereof 19 Group-1, 19 Group-2, 15 Group-3 patients, completed this study. Group-1 patients had the highest maximum systolic blood pressure, a higher daily cumulative insulin dose at admission, a higher body-mass index, and a higher plasma norepinephrine than control patients of Group 2. Group-3 patients had more documented hypoglycemic episodes (0.8 ± 0.5 per 24 h) than Group-2 patients (0.2 ± 0.3 per 24 h), however, they were not different to the ones in Group-1 patients (0.4 ± 0.4 per 24 h). Plasma norepinephrine and mean arterial blood pressure were higher Group-1 and Group-3 patients than in control patients of Group 2. At discharge, the daily cumulative insulin dose was reduced in Group-1 (− 18.4 ± 24.9 units) and in Group-3 patients (− 18.6 ± 22.7 units), but remained unchanged in Group-2 control patients (− 2.9 ± 15.6 units). Conclusions An association between hypoglycemic events and uncontrolled hypertension was found in this study.
Background:An association between hypoglycemia and arterial hypertension has been proposed. Here, for the first time, we report a case of a chronically over-dosed insulin therapy with uncontrolled hypertension, which improved after insulin-dose reduction.Case Presentation: A 73-year-old, male type-2 diabetic of Caucasian ethnicity was hospitalized for uncontrolled arterial hypertension and weakness. Prior to hospitalization, a fixed-dose insulin therapy (160 units per day) and antihypertensive medication with urapidile, valsartan and bisoprolol were prescribed. Hemoglobin A1c was 11.2%, symptomatic hypoglycemic episodes were not reported. During hospitalization, metformin, empagliflozin, and dulaglutide (1.5 mg per week) were added to insulin. Conventional insulin therapy was switched to an intensified insulin therapy with a cumulative daily dose of 46 units. 22 months after discharge, the medical therapy consisted of metformin, liraglutide, and insulin glargine (26 units per day), antihypertensive medication was reduced to bisoprolol and valsartan. Blood pressure was well controlled, hemoglobin A1c was 6.6%. As a likely explanation, undocumented, asymptomatic hypoglycemic events with a post-hypoglycemic hormonal stimulation were the cause for the poor glycemic and blood-pressure control. A step-wise reduction of insulin translated into a better glycemic and blood-pressure control.Conclusions: Undocumented, asymptomatic hypoglycemic events and post-hypoglycemic hormonal stimulation were the likely cause for the poor glycemic and blood-pressure control prior to index hospitalization. A step-wise reduction of insulin concurrently translated into a better glycemic and blood-pressure control.
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