Orthostatic Hypertension in Patients With Type 2 Diabetes

Abstract

OBJECTIVE -The prevalence and clinical importance of orthostatic hypertension (OHT) in diabetic patients has not been elucidated, in contrast to orthostatic hypotension, which is occasionally found in diabetic patients with autonomic neuropathy.RESEARCH DESIGN AND METHODS -The prevalence and severity of orthostatic hypertension was investigated in 277 Japanese male patients with type 2 diabetes, including 90 hypertensive patients and 128 nondiabetic age-matched male subjects. Patients treated with antihypertensive drugs were excluded from the study. OHT was defined as an increase in diastolic blood pressure (DBP) from Ͻ90 to Ն90 mmHg and/or an increase in systolic blood pressure (SBP) from Ͻ140 to Ն140 mmHg after standing from supine position. Clinical profiles and several serum biochemical parameters were determined in addition to chest X-rays and electrocardiograms.RESULTS -The prevalence of OHT in normotensive and hypertensive diabetic patients was significantly higher than in control subjects (12.8 vs. 1.8%, P Ͻ 0.01, for normotensive patients; 12.6 vs. 11.1%, not significant, for hypertensive patients). Orthostasis induced a mean increase of 6.8 Ϯ 11.4 mmHg in SBP and 9.1 Ϯ 5.2 mmHg in DBP in diabetic patients with OHT compared with those without OHT (Ϫ1.0 Ϯ 9.0 and 3.8 Ϯ 6.6 mmHg, respectively). Vibration sensation in the lower limb was reduced in diabetic patients with OHT, but the percent coefficient of variation of RR interval, cardio-to-thoracic ratio on chest X-ray, and serum triglyceride levels were higher in these patients compared with normotensive diabetic patients without OHT.CONCLUSIONS -Orthostatic hypertension is a novel complication in normotensive diabetic patients and may associate with early stage neuropathy and development of sustained hypertension.

Population-Based Study on the Prevalence and Correlates of Orthostatic Hypotension/Hypertension and Orthostatic Dizziness

“…Although OHT may be associated with cerebrovascular disease, hypertension, and diabetes mellitus (17,30,32), our results showed that age and supine systolic BP were the independent correlates of OHT. The lower prevalence of OHT in our study may result in an insignificant association between OHT and the above chronic diseases due to a lower statistical power (33).…”

Orthostatic hypertension: home blood pressure monitoring for detection and assessment of treatment with doxazosin

“…Moreover, it has been reported that OHT might be associated with overactivity of the sympathetic nervous system. 1,5,27 Therefore, doxazosin might break the vicious cycle between the sympathetic nervous hyperactivity, orthostatic BP increase and renal damage by reducing both the orthostatic BP increase and excessive urinary albumin excretion.…”

Orthostatic Hypertension A Measure of Blood Pressure Variation for Predicting Cardiovascular Risk

“…8 My group recently performed the Japan Morning Surge-1 (JMS-1) study in patients with early morning hypertension 14 and evaluated orthostatic BP changes in the early morning and before bedtime. The baseline data revealed increases in urinary albumin excretion and plasma levels of B-type natriuretic peptide (BNP: a useful marker of hypertensive heart disease) 15 in patients with orthostatic hypertension independent of BP in the seated position (Figure 6).…”

“…However, studies in recent years have shown that orthostatic hypertension is a new cardiovascular risk factor. [5][6][7][8][9] This review introduces the latest results on orthostatic hypertension, discusses its present status, and provides a new viewpoint. …”

“…7 In another study, orthostatic hypertension was defined as both BP in the lying position <140/90 mmHg and BP after 1-min standing ≥140/90 mmHg, and the incidence of orthostatic hypertension in 277 diabetic patients (12.6%) was significantly higher than that in 110 non-diabetic controls (1.8%). 8 We performed a 70° head-up tilt (HUT) test for 15 min after a 10-min supine rest. The orthostatic increase in BP (mean SBP from 6 to 10 min after tilting-SBP during 5 min before tilting) was calculated, and SBP increase ≥20 mmHg was defined as orthostatic hypertension and an SBP decrease ≥20 mmHg was defined as orthostatic hypotension.…”