Diastolic orthostatic hypertension and cardiovascular prognosis in type 2 diabetes: a prospective cohort study.
Wijkman. Magnus M; Länne. Toste T; Östgren. Carl Johan CJ; Nystrom. Fredrik H FH
Key Findings
- About 19% of the diabetic participants showed diastolic orthostatic hypertension (≥10 mmHg rise).
- Those with this rise had roughly half the risk of major cardiovascular events compared to people with normal orthostatic responses.
- Diastolic orthostatic hypotension (≥10 mmHg drop) was associated with higher aortic pulse wave velocity and thicker carotid intima‑media, markers of vascular damage.
Practical Outcomes
- For biohackers and self‑trackers, measuring blood pressure while sitting and then standing could give an extra clue about cardiovascular risk in diabetes. A rise in diastolic pressure on standing might be a reassuring sign, while a drop could flag the need for closer heart‑health monitoring. However, the study does not suggest changing behavior or dosing based on these readings.
Summary
In people with type 2 diabetes, a noticeable rise in diastolic blood pressure when they stand up (at least 10 mmHg) is fairly common and appears to be linked to a lower chance of heart attacks, strokes, or cardiovascular death. Conversely, a big drop in diastolic pressure on standing is tied to signs of stiffer arteries and thicker carotid walls, which are risk factors for heart disease.
Abstract
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. 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. 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. Diastolic orthostatic hypertension is common in patients with type 2 diabetes, and may be a novel marker for decreased cardiovascular risk in these patients.
Study Information
pubmed
2016
2016-06-02T00:00:00.000Z
10.1186/s12933-016-0399-0
31
45