Orthostatic hypotension in diabetic patients—10-year follow-up study

• Published in: Journal of diabetes and its complications 2016-01, Vol.30 (1), p.67-71
• Main Authors: Gaspar, Ludovit, Kruzliak, Peter, Komornikova, Andrea, Celecova, Zuzana, Krahulec, Boris, Balaz, David, Sabaka, Peter, Caprnda, Martin, Kucera, Marek, Rodrigo, Luis, Uehara, Yoshio, Dukat, Andrej
• Format: Article
• Language: English
• Subjects: Adult; Blood pressure; Cardiovascular Diseases - complications; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - mortality; Cardiovascular Diseases - physiopathology; Cohort Studies; Diabetes; Diabetes mellitus; Diabetes Mellitus, Type 1 - complications; Diabetes Mellitus, Type 2 - complications; Diabetic Angiopathies - complications; Diabetic Angiopathies - epidemiology; Diabetic Angiopathies - mortality; Diabetic Angiopathies - physiopathology; Diabetic Cardiomyopathies - complications; Diabetic Cardiomyopathies - epidemiology; Diabetic Cardiomyopathies - mortality; Diabetic Cardiomyopathies - physiopathology; Diabetic cardiovascular autonomic neuropathy; Diabetic Nephropathies - complications; Diabetic Nephropathies - epidemiology; Diabetic Nephropathies - mortality; Diabetic Nephropathies - physiopathology; Diabetic Neuropathies - complications; Diabetic Neuropathies - epidemiology; Diabetic Neuropathies - mortality; Diabetic Neuropathies - physiopathology; Diabetic neuropathy; Diabetic retinopathy; Endocrinology & Metabolism; Family medical history; Follow-Up Studies; Fourier transforms; Heart rate; Hospitals; Hospitals, University; Humans; Hypertension; Hypotension, Orthostatic - complications; Hypotension, Orthostatic - epidemiology; Hypotension, Orthostatic - mortality; Hypotension, Orthostatic - physiopathology; Microvascular and macrovascular complications; Middle Aged; Mortality; Nervous system; Obesity; Orthostatic hypotension; Outpatient Clinics, Hospital; Prevalence; Renal Insufficiency - complications; Renal Insufficiency - epidemiology; Renal Insufficiency - mortality; Renal Insufficiency - physiopathology; Retrospective Studies; Risk Factors; Severity of Illness Index; Slovakia - epidemiology; Statistical analysis
• ISSN: 1056-8727; 1873-460X
• DOI: 10.1016/j.jdiacomp.2015.08.020

Abstract Introduction Cardiovascular autonomic neuropathy in diabetics is a common but often underestimated and underdiagnosed complication of diabetes mellitus. One of the most clinical apparent forms of cardiovascular autonomic neuropathy is orthostatic hypotension. Objectives To retrospectively assess the association of the orthostatic hypotension (OH) with macrovascular and microvascular complications of diabetes mellitus and to determine its effect on mortality. Design and methods We retrospectively analyzed 187 patients with diabetes mellitus (60 patients with diabetes type 1 and 127 patients with diabetes type 2). Patients were divided into groups according to presence or absence of OH and type of diabetes. Association of OH with macrovascular and microvascular complications was evaluated and the effect of OH on 10-year all-cause mortality was also assessed. Results OH was present in 31.7% of patients with diabetes type 1 (DM1) and in 32.3% of patients with diabetes type 2 (DM2). OH was positively associated with the prevalence of myocardial infarction in DM1 (OR = 10.67) and with prevalence of stroke in DM2 (OR = 3.33). There was also a strong association of OH and the prevalence of peripheral artery disease in both DM1 (OR = 14.18) and DM2 (OR = 3.26). Patients with both types of diabetes and OH had significantly higher prevalence of nephropathy (DM1 OR = 8.68, DM2 OR = 3.24), retinopathy (DM1 OR = 8.09, DM2 OR = 4.08) and peripheral neuropathy (DM1 OR = 17.14, DM2 OR = 7.51) Overall 10 year mortality rate was higher in diabetic patients with OH. Conclusions Presence of OH in diabetics is associated with higher prevalence of macrovascular and microvascular complications of diabetes mellitus and also with higher 10-year mortality.