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Diastolic orthostatic hypertension and cardiovascular prognosis in type 2 diabetes: a prospective cohort study
Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in East Östergötland, Department of Internal Medicine in Norrköping.
Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.ORCID iD: 0000-0002-9095-403X
Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, "Primary Health Care in Motala".
Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Endocrinology.ORCID iD: 0000-0002-1680-1000
2016 (English)In: Cardiovascular Diabetology, ISSN 1475-2840, E-ISSN 1475-2840, Vol. 15, no 83, 1-10 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: In 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.

METHODS: Office 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.

RESULTS: Diastolic 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.

CONCLUSIONS: Diastolic orthostatic hypertension is common in patients with type 2 diabetes, and may be a novel marker for decreased cardiovascular risk in these patients.

Place, publisher, year, edition, pages
BioMed Central, 2016. Vol. 15, no 83, 1-10 p.
Keyword [en]
Arterial stiffness, Blood pressure, Cardiovascular risk, Carotid intima-media thickness, Events, Orthostatic hypotension, Type 2 diabetes mellitus
National Category
Clinical Medicine
Identifiers
URN: urn:nbn:se:liu:diva-129959DOI: 10.1186/s12933-016-0399-0ISI: 000377852600001PubMedID: 27255168OAI: oai:DiVA.org:liu-129959DiVA: diva2:945683
Note

Funding agencies: FORSS; Research Council of Southeastern Sweden; King GustafV and Queen Victoria Freemason Foundation, Sweden

Available from: 2016-07-02 Created: 2016-07-02 Last updated: 2017-11-28Bibliographically approved

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Wijkman, MagnusLänne, TosteÖstgren, Carl JohanNyström, Fredrik H
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Division of Cardiovascular MedicineFaculty of Medicine and Health SciencesDepartment of Internal Medicine in NorrköpingDepartment of Thoracic and Vascular SurgeryDivision of Community Medicine"Primary Health Care in Motala"Department of Endocrinology
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