Abstract
BackgroundIn patients with type 2 diabetes, the prognostic impact of an orthostatic rise in blood pressure is not known. Therefore, the aim of this study was to determine the prognostic implications of the diastolic orthostatic blood pressure response in a cohort of patients with type 2 diabetes. We also evaluated associations between different orthostatic blood pressure responses and markers of subclinical cardiovascular organ damage.MethodsOffice blood pressures were measured in the sitting and in the standing position in 749 patients with type 2 diabetes who participated in the CARDIPP study (Cardiovascular Risk factors in Patients with Diabetes—a Prospective study in Primary care). Diastolic orthostatic hypertension was defined as a rise of diastolic blood pressure ≥10 mmHg and diastolic orthostatic hypotension was defined as a drop of diastolic blood pressure ≥10 mmHg. Recruitment took place between the years 2005–2008, and patients were followed until any of the primary outcome events (cardiovascular death or hospitalization for either myocardial infarction or stroke) occurred or until December 31st, 2014. Measurements of aortic pulse wave velocity and of carotid intima-media thickness were performed at base-line.ResultsDiastolic orthostatic hypertension was found in 140 patients (18.7 %) and was associated with significantly lower risk of cardiovascular events (crude hazard ratio compared with patients with normal systolic and diastolic orthostatic blood pressure response: 0.450, 95 % C.I. 0.206–0.987, P = 0.046). Diastolic orthostatic hypotension was found in 31 patients (4.1 %) and was associated with higher values for aortic pulse wave velocity and carotid intima-media thickness, compared with patients with normal systolic and diastolic orthostatic blood pressure response.ConclusionsDiastolic orthostatic hypertension is common in patients with type 2 diabetes, and may be a novel marker for decreased cardiovascular risk in these patients.
Highlights
In patients with type 2 diabetes, the prognostic impact of an orthostatic rise in blood pressure is not known
During a median follow-up time of 7.8 years, there were 75 endpoint events (42 events related to ischemic heart disease including 37 myocardial infarctions, 27 events related to ischemic stroke, four events related to intracerebral hemorrhage, one event related to subdural bleeding and one event related to congestive heart failure)
Fifty-eight events occurred among the 534 patients with normal systolic and diastolic orthostatic blood pressure responses (10.9 %), five events occurred among the 45 patients with systolic orthostatic hypertension (11.1 %), two events occurred among the 24 patients with systolic orthostatic hypotension (8.3 %), seven events occurred among the 140 patients with diastolic orthostatic hypertension (5.0 %) and six events occurred among the 31 patients with diastolic orthostatic hypotension (19.4 %)
Summary
In patients with type 2 diabetes, the prognostic impact of an orthostatic rise in blood pressure is not known. The aim of this study was to determine the prognostic implications of the diastolic orthostatic blood pressure response in a cohort of patients with type 2 diabetes. Orthostatic hypotension is an established marker for cardiovascular risk in patients with hypertension [3, 4], in the elderly [5,6,7,8] and in the general population [9,10,11,12]. Less is known, about the prevalence and clinical impact of the reverse phenomenon, orthostatic hypertension, which implies an exaggerated rise in blood pressure when assuming an upright position [13, 14]. We explored differences in the extent of subclinical cardiovascular organ damage, measured as aortic pulse wave velocity (PWV) and carotid intima-media thickness (IMT), between patients with differing orthostatic blood pressure responses
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