Twenty-four-hour blood pressure profile, orthostatic hypotension, and cardiac dysautonomia in elderly type 2 diabetic hypertensive patients

Purpose The aim of this study was to evaluate the relationship between orthostatic hypotension (OH), defined as a decrease in systolic blood pressure (SBP) ≥20 mmHg and/or a decrease in diastolic blood pressure (DBP) ≥10 mmHg, and 24-h ambulatory BP profile in elderly hypertensive type 2 diabetic pa...

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Bibliographic Details
Published in:Clinical autonomic research 2016-12, Vol.26 (6), p.433-439
Main Authors: Costa, Alfredo, Bosone, Daniele, Ramusino, Matteo Cotta, Ghiotto, Natascia, Guaschino, Elena, Zoppi, Annalisa, D’Angelo, Angela, Fogari, Roberto
Format: Article
Language:English
Subjects:
Aged
Blood Pressure
Blood Pressure Monitoring, Ambulatory
Cardiology
Diabetes
Diabetes Mellitus, Type 2 - physiopathology
Diabetic Neuropathies - physiopathology
Electrocardiography
Endocrinology
Female
Gastroenterology
Heart Diseases - physiopathology
Humans
Hypotension, Orthostatic - physiopathology
Male
Medicine
Medicine & Public Health
Neurology
Ophthalmology
Polysomnography
Primary Dysautonomias - physiopathology
Research Article
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Summary:Purpose The aim of this study was to evaluate the relationship between orthostatic hypotension (OH), defined as a decrease in systolic blood pressure (SBP) ≥20 mmHg and/or a decrease in diastolic blood pressure (DBP) ≥10 mmHg, and 24-h ambulatory BP profile in elderly hypertensive type 2 diabetic patients. Methods After a 2-week antihypertensive wash-out period, 200 hypertensive well-controlled diabetic outpatients, aged 65–75 years, underwent a clinical examination, including BP measurements, ECG, 24-h ABP monitoring (ABPM), an orthostatic test, and three tests for cardiovascular autonomic function assessment [deep breathing, heart rate (HR) variability, resting HR]. Results According to their nighttime BP profile, patients were divided into three groups: dippers ( n  = 86) (BP fall during nighttime ≥10 %), non-dippers ( n  = 80) (BP fall during nighttime 0–10 %), and reverse dippers ( n  = 34) (nighttime BP > daytime BP). Orthostatic test produced a significantly greater orthostatic SBP fall in dippers and even more in reverse dippers. In these latter, a significant fall was observed also in DBP. Prevalence of OH was 9.3 % in dippers, 30 % in non-dippers, and 79.4 % in reverse dippers. Conclusions In elderly hypertensive type 2 diabetics, a blunted nocturnal BP fall is associated with OH and autonomic dysfunction. These data suggest that ABPM should be performed in the assessment of hypertensive diabetic patients in whom the cardiovascular dysautonomia is suspected or the signs of it are present (such as OH).
ISSN:0959-9851
1619-1560
DOI:10.1007/s10286-016-0381-7