What is the clinical evidence from this study?

Study design: Cohort. Population: Type 2 diabetes (n=749). Intervention: Diastolic orthostatic hypertension vs. Normal systolic and diastolic orthostatic blood pressure response. Primary outcome: Composite of cardiovascular death or hospitalization for either myocardial infarction or stroke (HR 0.450, 95% CI 0.206-0.987, p=0.046).

June 2, 2016Open Access

Diastolic orthostatic hypertension and cardiovascular prognosis in type 2 diabetes: a prospective cohort study

Key Result

Diastolic orthostatic hypertension was associated with a significantly lower risk of cardiovascular events (HR 0.450) compared to a normal orthostatic blood pressure response in patients with type 2 diabetes.

Study Design

Type

Cohort (n=749)

Multicenter

Yes

Structured PICO

Does diastolic orthostatic hypertension reduce the composite of cardiovascular death, myocardial infarction, or stroke in patients with type 2 diabetes?

Population

749 middle-aged patients (55-65 years) with type 2 diabetes treated in primary care, followed for a median of 7.8 years.

Exposure

Diastolic orthostatic hypertension (rise of diastolic blood pressure ≥10 mmHg upon standing for 2 minutes)

Comparator

Normal systolic and diastolic orthostatic blood pressure response (change of systolic blood pressure within -19 to +19 mmHg and diastolic blood pressure within -9 to +9 mmHg)

Outcome

Composite endpoint of the first non-fatal or fatal event of hospitalization for acute myocardial infarction, stroke, or cardiovascular mortality at median 7.8 years follow-upcomposite

In middle-aged patients with type 2 diabetes, diastolic orthostatic hypertension is a common finding associated with a decreased risk of incident cardiovascular events.

Main Result

Hazard Ratio: 0.45 (95% CI 0.206–0.987)

Absolute Event Rate: 5% vs 10.9%

p-value: p=0.046

Limitations

Few patients fulfilled the criteria for diastolic or systolic orthostatic hypotension, limiting statistical power
Relatively few events precluded exploration of gender differences and separate analyses of patients with or without antihypertensive medications
Orthostatic blood pressure response was diagnosed at a single occasion, and reproducibility may be poor
Blood pressure was measured in the sitting rather than supine position, which may have underestimated orthostatic hypotensive reactions
Standing blood pressure was measured at 2 minutes, potentially missing delayed orthostatic hypotension

Abstract

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: Diastolic orthostatic hypertension is common in patients with type 2 diabetes, and may be a novel marker for decreased cardiovascular risk in these patients.

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Cite This Study

Wijkman et al. (Thu,) conducted a cohort in Type 2 diabetes (n=749). Diastolic orthostatic hypertension vs. Normal systolic and diastolic orthostatic blood pressure response was evaluated on Composite of cardiovascular death or hospitalization for either myocardial infarction or stroke (HR 0.450, 95% CI 0.206-0.987, p=0.046). Diastolic orthostatic hypertension was associated with a significantly lower risk of cardiovascular events (HR 0.450) compared to a normal orthostatic blood pressure response in patients with type 2 diabetes.

synapsesocial.com/papers/6a21d5e5caef8a5f82c012ed https://doi.org/https://doi.org/10.1186/s12933-016-0399-0

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