Orthostatic hypotension in patients with arterial hypertension and carbohydrate metabolism disorders

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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.

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作者简介

Oksana Antropova

Altai State Medical University of the Ministry of Healthcare of Russia

编辑信件的主要联系方式.
Email: antropovaon@mail.ru
ORCID iD: 0000-0002-6233-7202

MD, Dr. Sci. (Medicine), professor, professor of the Department of faculty therapy and occupational diseases

俄罗斯联邦, 6565038, Barnaul, 40 Lenina St.

Violetta Nazarova

Clinical Hospital “RZD-Medicine”

Email: violetta.nazarova@bk.ru
ORCID iD: 0009-0009-4431-4961

MD, general practitioner

俄罗斯联邦, 6565038, Barnaul, 20 Molodezhnaya St.

Ulyana Voloshina

Altai State Medical University of the Ministry of Healthcare of Russia

Email: voloshina_ulechka@mail.ru
ORCID iD: 0009-0004-5882-6750

6th year student

俄罗斯联邦, 6565038, Barnaul, 40 Lenina St.

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