Orthostatic Hypertension in Patients With Type 2 Diabetes
- Mototaka Yoshinari, MD, PHD1,
- Masanori Wakisaka, MD, PHD2,
- Udai Nakamura, MD2,
- Maki Yoshioka, MD2,
- Yuji Uchizono, MD2 and
- Masanori Iwase, MD, PHD2
- 1Department of Endocrinology and Metabolism, National Fukuoka Higashi Hospital, Koga, Fukuoka
- 2Second Department of Internal Medicine, Kyushu University Hospital, Maidashi, Higashiku, Fukuoka, Japan
Abstract
OBJECTIVE—The prevalence and clinical importance of orthostatic hypertension (OHT) in diabetic patients has not been elucidated, in contrast to orthostatic hypotension, which is occasionally found in diabetic patients with autonomic neuropathy.
RESEARCH DESIGN AND METHODS—The prevalence and severity of orthostatic hypertension was investigated in 277 Japanese male patients with type 2 diabetes, including 90 hypertensive patients and 128 nondiabetic age-matched male subjects. Patients treated with antihypertensive drugs were excluded from the study. OHT was defined as an increase in diastolic blood pressure (DBP) from <90 to ≥90 mmHg and/or an increase in systolic blood pressure (SBP) from <140 to ≥140 mmHg after standing from supine position. Clinical profiles and several serum biochemical parameters were determined in addition to chest X-rays and electrocardiograms.
RESULTS—The prevalence of OHT in normotensive and hypertensive diabetic patients was significantly higher than in control subjects (12.8 vs. 1.8%, P < 0.01, for normotensive patients; 12.6 vs. 11.1%, not significant, for hypertensive patients). Orthostasis induced a mean increase of 6.8 ± 11.4 mmHg in SBP and 9.1 ± 5.2 mmHg in DBP in diabetic patients with OHT compared with those without OHT (−1.0 ± 9.0 and 3.8 ± 6.6 mmHg, respectively). Vibration sensation in the lower limb was reduced in diabetic patients with OHT, but the percent coefficient of variation of RR interval, cardio-to-thoracic ratio on chest X-ray, and serum triglyceride levels were higher in these patients compared with normotensive diabetic patients without OHT.
CONCLUSIONS—Orthostatic hypertension is a novel complication in normotensive diabetic patients and may associate with early stage neuropathy and development of sustained hypertension.
- CTR, cardio-to-thoracic ratio
- CVRR, coefficient of variation of RR interval
- DBP, diastolic blood pressure
- ECG, electrocardiogram
- IMT, intima media thickness
- JNC IV, fourth Joint National Committee on the Prevention, Detection, Evaluation and Treatment of High Blood Pressure
- OHT, orthostatic hypertension
- QTc, corrected QT interval
- SBP, systolic blood pressure
Footnotes
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Address correspondence and reprint requests to Mototaka Yoshinari, MD, Department of Internal Medicine, National Fukuoka-Higashi Hospital, Tidori 1-1-1, Koga, Fukuoka, 811-3195, Japan. E-mail: yosinari{at}intmed2.med.kyushu-u.ac.jp.
Received for publication 15 February 2001 and accepted in revised form 3 July 2001.
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