Orthostatic hypotension as a marker of increased arterial stiffness in diabetes mellitus

BACKGROUND: Orthostatic hypotension (OH) is associated with adverse cardiovascular outcomes and may reflect underlying autonomic and vascular dysfunction. Arterial stiffness is a key determinant of cardiovascular risk; however, its relationship with OH in patients with diabetes mellitus (DM) remains unclear. OBJECTIVE: To evaluate factors associated with OH and investigate the relationship between arterial stiffness parameters and OH in patients with DM. METHODS: This single-center cross-sectional study included 193 patients with DM. Orthostatic blood pressure was measured in the supine position and 3 min after standing. Arterial stiffness was assessed using oscillometric pulse wave velocity (PWV) and related parameters with the Mobil-O-Graph device. Clinical, laboratory, and medication data were analyzed. Logistic regression analyses were performed to identify factors associated with OH. RESULTS: OH was present in 56 patients (29%). Patients with OH had significantly higher central blood pressure and arterial stiffness parameters, including PWV, augmentation pressure, and augmentation index. In multivariate analysis, female sex, older age, diabetic neuropathy, and PWV were independently associated with OH. PWV remained significantly associated with OH after adjustment for confounders. No significant differences were observed between groups regarding antihypertensive medication classes. CONCLUSION: In patients with DM, OH is independently associated with increased arterial stiffness and diabetic neuropathy. These findings suggest a link between orthostatic blood pressure dysregulation and adverse vascular characteristics. Prospective studies are needed to clarify causal relationships and clinical implications.