Further Investigation of the Negative Association between Hypertension and Peripheral Neuropathy in the Elderly: An Oklahoma Physicians Resource/Research Network (OKPRN) Study

Abstract

Background: In a previous cross-sectional study of age-associated peripheral neuropathy (AAPN), we found that a history of hypertension was protective. The purpose of this study, conducted in the same cohort, was to investigate further this association in the same subjects and in a comparison group of older subjects with diabetes mellitus.Methods: Baseline data from 584 subjects involved in a longitudinal study of primary care patients 65 years of age and older, with no history of 10 medical conditions known to cause peripheral neuropathy, were analyzed for associations between peripheral neuropathy by examination and history of hypertension, number of antihypertensive medications, systolic blood pressure, diastolic blood pressure, pulse pressure, and orthostatic hypotension. In addition, we examined associations between neuropathy at baseline and use of specific classes of antihypertensive medications and non-steroidal anti-inflammatory agents (NSAIDs) in year 3. The analyses were repeated in 110 subjects with diabetes mellitus.Results: History of hypertension, but not the other hypertension-related variables, was negatively associated (OR, 0.60; 95% CI: 0.40 to 0.90) with AAPN after controlling for age and body mass index (BMI). In 287 subjects evaluated in the 3rd year of the study, ␤-blocking agents (OR, 3.56; 95% CI: 1.58 to 8.03) and NSAIDs (OR, 2.65; 95% CI: 1.37 to 5.10) were positively associated with AAPN. In subjects with diabetes mellitus, a history of hypertension was again protective, but current pulse pressure (OR, 1.03; 95% CI: 1.00 to 1.05) was a positive predictor of peripheral neuropathy. There were interesting interactions between pulse pressure and military service and pulse pressure and BMI in diabetic patients.Conclusions: The negative association between hypertension and AAPN remains unexplained. The positive association between pulse pressure and neuropathy in diabetic subjects supports findings from previous studies and suggests that AAPN and the neuropathy of diabetes may be distinct entities.

Arterial stiffness is elevated in normotensive type 2 diabetic patients with peripheral neuropathy

“…What is more, differentiation between normotensive, hypertensive with or without PN was not studied. In a cross-sectional study of primary care patients over 65 years of age, Cho et al reported, like in our study, that pulse pressure -a surrogate approximation of stiffnesswas positively associated with the presence of PN in diabetes [36]. Similar results were also found when using brachial-ankle PWV [16,17,19].…”

The Use of Anthropometric Measurements of Obesity in Prediction of Microvascular Complications in Obese Type 2 Diabetic Patients

“…Our study defi nitely supported the inconclusiveness of data on the relationship of BMI and microvascular complications [31][32][33][34][35][36][37] . It is known that anthropometric measurements of BMI, WHR and WC do not correlate entirely and are indices of diff erent aspects of obesity.…”

Visit-to-visit systolic blood pressure variability and microvascular complications among patients with diabetes

“…We could not find any previous study that examined its relationship with SBP variability. This may be because the general relationship between high BP and diabetic neuropathy is not well established yet (Cho, Mold, & Roberts, 2006; Forrest, Maser, Pambianco, Becker, & Orchard, 1997; Stella, Ellis, Maser, & Orchard, 2000; UK Prospective Diabetes Study Group, 1998). Our results suggest an insignificant association between SBP mean and the risk of neuropathy (see Table A).…”