Orthostatic hypotension in patients with arterial hypertension and carbohydrate metabolism disorders


DOI: https://dx.doi.org/10.18565/therapy.2024.5.59-66

Antropova O.N., Nazarova V.V., Voloshina U.E.

1) Altai State Medical University of the Ministry of Healthcare of Russia, Barnaul; 2) Clinical Hospital “RZD-Medicine”, Barnaul
Abstract. Orthostatic hypotension (OH) occurs more frequently in patients with diabetes mellitus (DM), than in general population.
The aim: to identify risk factors for OH in patients with DM and impaired glucose tolerance (IGT), its correlation with autonomic dysfunction and medicamentous antihypertensive therapy.
Material and methods. The study included 70 patients with treated arterial hypertension with DM or IGT (mean age 65.8 ± 19 years). Orthostatic response was assessed using the active test method; OH was estimated when systolic blood pressure (SBP) decreased by 20 mm Hg and/or diastolic by 10 mm Hg. Autonomic symptoms of diabetic neuropathy were assessed using SAS (Survey of Autonomic Symptoms) scale.
Results. 21 patients (30%) had OH, and remaining 49 (70%) did not have it. In patients in the compared groups, the average age was comparable, but patients with OH were 27.2% more likely (x² = 4.444, p = 0.036) to be older than 65 years. The incidence of controlled hypertension, atrial fibrillation, heart failure, diabetic polyneuropathy and nephropathy (glomerular filtration rate < 60 ml/min.) did not differ depending on the presence/absence of OH. In patients with OH, anemia was 3.9 times (x² = 19.66, p < 0.05) more common. The frequency of use of combined 2-, 3-, 4-component antihypertensive therapy in patients of the analyzed groups was comparable. The total assessment of orthostasis, vasomotor and sudomotor reactions according to SAS questionnaire of less than 10 points in patients with OH was 2.3 times less frequent (x² = 4.207, p = 0.041) comparatively to persons without OH: 19% (n = 4) versus 44.9% (n = 22). There was a moderate direct correlation between the total score on SAS questionnaire and age (r = 0.48, p = 0.034), change in SBP (in mm Hg) during an orthostatic test (r = 0.29, p = 0.049). By constructing single-factor logistic regression models, predictors of OH development were identified. Anemia, atherosclerosis of peripheral arteries, pulse pressure above 60 mm Hg are among them.
Conclusion. In 30% of patients with DM and IGT, OH is detected, in most of them (70%) – in the 1st minute of an active orthostatic test. Patients with OH are characterized by a higher incidence of anemia and more often have an elderly age. Patients with DM tend to have a higher incidence of OH comparatively to individuals with IGT. Medicamentous combined antihypertensive therapy was comparable in patients with and without OH.
Keywords: orthostatic hypotension, impaired glucose tolerance, diabetes mellitus, arterial hypertension
Read entire article

Literature

1. Кобалава Ж.Д., Конради А.О., Недогода С.В. с соавт. Артериальная гипертензия у взрослых. Клинические рекомендации 2020. Российский кардиологический журнал. 2020; 25(3): 149–218. (Kobalava Zh.D., Konradi A.O., Nedogoda S.V. et al. Arterial hypertension in adults. Clinical guidelines 2020. Rossiyskiy kardiologicheskiy zhurnal = Russian Journal of Cardiology. 2020; 25(3): 149–218 (In Russ.)).


https://doi.org/10.15829/1560-4071-2020-3-3786. EDN: TCRBRB.


2. Idiaquez Rios J.F., Lovblom L.E., Perkins B.A., Bril V. Orthostatic blood pressure changes and diabetes duration. J Diabetes Complications. 2022; 36(5): 108169.


https://doi.org/10.1016/j.jdiacomp.2022.108169. PMID: 35307262.


3. Gannon J., Claffey P., Laird E. et al. The cross-sectional association between diabetes and orthostatic hypotension in community-dwelling older people. Diabet Med. 2020; 37(8): 1299–307.


https://doi.org/10.1111/dme.14187. PMID: 31770459.


4. Jinbiao Z., Haiyan C., Tong W. et al. Effects of orthostatic hypotension on cognition in type 2 diabetes mellitus. Ann Neurol. 2019; 86(5): 754–61.


https://doi.org/10.1002/ana.25578. PMID: 31397912.


5. Shorikov I., Shorikova D.V. Phenotypes of arterial hypertension in patients with diabetes mellitus type 2: Orthostatic hypotension and daily variability of blood pressure. ESC e – Journal of Cardiology Practice. 2022; 22(14). URL: https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-22/phenotypes-of-arterial-hypertension-in-patients-with-diabetes-mellitus-type-2-o (date of access – 20.05.2024).


6. Novak V., Hajjar I. The relationship between blood pressure and cognitive function. Nat Rev Cardiol. 2010; 7(12): 686–98.


https://doi.org/10.1038/nrcardio.2010.161. PMID: 20978471. PMCID: PMC3328310.


7. Mol A., Hoang P.T.S.B., Sharmin S. et al. Orthostatic hypotension and falls in older adults: A systematic review and meta-analysis. J Am Med Dir Assoc. 2019; 20(5): 589–597.e5.


https://doi.org/10.1016/j.jamda.2018.11.003. PMID: 30583909.


8. Wieling W., Kaufmann H., Claydon V.E. et al. Diagnosis and treatment of orthostatic hypotension. Lancet Neurol. 2022; 21(8): 735–46.


https://doi.org/10.1016/S1474-4422(22)00169-7. PMID: 35841911. PMCID: PMC10024337.


9. Дедов И.И., Шестакова М.В., Майоров А.Ю. с соавт. Сахарный диабет 2 типа у взрослых. Сахарный диабет. 2020; 23(2S): 4–102. (Dedov I.I., Shestakova M.V., Mayorov A.Yu. et al. Diabetes mellitus type 2 in adults. Sakharnyy diabet = Diabetes Mellitus. 2020; 23(2S): 4–102 (In Russ.)).


https://doi.org/10.14341/DM12507. EDN: YBRIMY.


10. Клинические рекомендации. Хроническая болезнь почек (ХБП). Ассоциация нефрологов. Рубрикатор клинических рекомендаций Минздрава России. 2021. ID: 469. Доступ: https://cr.minzdrav.gov.ru/recomend/469_2 (дата обращения – 20.05.2024). (Clinical guidelines. Chronic kidney disease (CKD). Association of Nephrologists. Rubricator of clinical guidelines of the Ministry of Healthcare of Russia. 2021. ID: 469. URL: https://cr.minzdrav.gov.ru/recomend/469_2 (date of access – 20.05.2024) (In Russ.)).


11. Оленская Т.Л., Козловский В.И. Методы исследования ортостатических реакций. Вестник Витебского государственного медицинского университета. 2003; 2(1): 26–31. (Olenskaya T.L., Kozlovsky V.I. Methods of investigation of orthostatic reactions. Vestnik Vitebskogo gosudarstvennogo meditsinskogo universiteta = Bulletin of Vitebsk State Medical University. 2003; 2(1): 26–31 (In Russ.)). EDN: OXIWWF.


12. Zilliox L.A., Russell J.W. Physical activity and dietary interventions in diabetic neuropathy: A systemic review. Clin Auton Res. 2019; 29(4): 443–55.


https://doi.org/10.1007/s10286-019-00607-x. PMID: 31076938. PMCID: PMC6697618.


13. Zilliox L., Peltier A.C., Wren P.A. et al. Assessing autonomic dysfunction in early diabetic neuropathy The Survey of Autonomic Symptoms. Neurology. 2011; 76(12): 1099–105.


https://doi.org/10.1212/WNL.0b013e3182120147. PMID: 21422460. PMCID: PMC3068012.


14. Kim S.H., Lee K.A., Jin H.Y. et al. Relationship between the Korean version Survey of The Autonomic Symptoms score and cardiac autonomic neuropathy parameters in patients with diabetic peripheral neuropathy. Diabetes Metab J. 2014; 38(5): 349–55.


https://doi.org/10.4093/dmj.2014.38.5.349. PMID: 25349822. PMCID: PMC4209349.


15. Saedon N.I., Pin Tan M., Frith J. The prevalence of orthostatic hypotension: A systematic review and meta-analysis. J Gerontol A Biol Sci Med Sci. 2020; 75(1): 117–22.


https://doi.org/10.1093/gerona/gly188. PMID: 30169579. PMCID: PMC6909901.


16. Gibbons C.H., Freeman R. Delayed orthostatic hypotension: A frequent cause of orthostatic intolerance. Neurology. 2006; 67(1): 28–32.


https://doi.org/10.1212/01.wnl.0000223828.28215.0b. PMID: 16832073.


17. Gibbons C.H., Freeman R. Clinical implications of delayed orthostatic hypotension: A 10-year follow-up study. Neurology. 2015; 85(16): 1362–67.


https://doi.org/10.1212/WNL.0000000000002030. PMID: 26400576. PMCID: PMC4626242.


18. Finucane C., O’Connell M.D., Donoghue O. et al. Impaired orthostatic blood pressure recovery is associated with unexplained and injurious falls. J Am Geriatr Soc. 2017; 65(3): 474–82.


https://doi.org/10.1111/jgs.14563. PMID: 28295143.


19. Juraschek S.P., Daya N., Rawlings A.M. et al. Association of history of dizziness and long-term adverse outcomes with early vs later orthostatic hypotension assessment times in middle-aged adults. JAMA Intern Med. 2017; 177(9): 1316–23.


https://doi.org/10.1001/jamainternmed.2017.2937. PMID: 28738139. PMCID: PMC5661881.


20. Воробьева Н.М., Лузина А.В., Малая И.П. с соавт. Ортостатическая гипотензия и ее ассоциации с гериатрическими синдромами у лиц старше 65 лет: данные исследования ЭВКАЛИПТ. Артериальная гипертензия. 2023; 29(3): 253–265. (Vorobyeva N.M., Luzina A.V., Malaya I.P. et al. Orthostatic hypotension and its associations with geriatric syndromes in subjects over 65 years old: Data from EVKALIPT study. Arterial’naya gipertenziya = Arterial Hypertension. 2023; 29(3): 253–265 (In Russ.)).


https://doi.org/10.18705/1607-419X-2023-29-3-253-265. EDN: ZJVHWK.


21. Головина Г.А., Дупляков Д.В. Ортостатическая гипотензия. Взгляд кардиолога. Артериальная гипертензия. 2014; 20(2): 75–85. (Golovina G.A., Duplyakov D.V. Orthostatic hypotension: The cardiologist’s view. Arterial’naya gipertenziya = Arterial Hypertension. 2014; 20(2): 75–85 (In Russ.)).


https://doi.org/10.18705/1607-419X-2014-20-2-75-85. EDN: SCJOLP.


22. Boulton A.J., Vinik A.I., Arezzo J.C. et al. Diabetic neuropathies: A statement by the American Diabetes Association. Diabetes Care. 2005; 28(4): 956–62.


https://doi.org/10.2337/diacare.28.4.956. PMID: 15793206.


23. Yajnik C.S., Kantikar V., Pande A. et al. Screening of cardiovascular autonomic neuropathy in patients with diabetes using non-invasive quick and simple assessment of sudomotor function. Diabetes Metab J. 2013; 39(2): 126–31.


https://doi.org/10.1016/j.diabet.2012.09.004. PMID: 23159130.


About the Autors

Oksana N. Antropova, MD, Dr. Sci. (Medicine), professor, professor of the Department of faculty therapy and occupational diseases, Altai State Medical University of the Ministry of Healthcare of Russia. Address: 6565038, Barnaul, 40 Lenina St.
E-mail: antropovaon@mail.ru
ORCID: https://orcid.org/0000-0002-6233-7202
Violetta V. Nazarova, MD, general practitioner at the Clinical Hospital “RZD-Medicine”. Address: 6565038, Barnaul, 20 Molodezhnaya St.
E-mail: violetta.nazarova@bk.ru
ORCID: https://orcid.org/0009-0009-4431-4961
Ulyana E. Voloshina, 6th year student of the Institute of clinical medicine of Altai State Medical University of the Ministry of Healthcare of Russia. Address: 6565038, Barnaul, 40 Lenina St.
E-mail: voloshina_ulechka@mail.ru
ORCID: https://orcid.org/0009-0004-5882-6750


Similar Articles

Back to Content

Бионика Медиа