The primary aim was to determine the prognostic impact of the diastolic and systolic orthostatic blood pressure responses in patients with type 2 diabetes. We also evaluated associations between different orthostatic blood pressure responses and markers of subclinical cardiovascular organ damage.Design and method:
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 of 10 mmHg or more, diastolic orthostatic hypotension was defined as a drop of diastolic blood pressure 10 mmHg or more, systolic orthostatic hypertension was defined as a rise of systolic blood pressure of 20 mmHg or more, and systolic orthostatic hypotension was defined as a drop of systolic blood pressure of 20 mmHg or more. Recruitment took place between the years 2005 – 2008. 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 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 without diastolic orthostatic hypertension: 0.438, 95% C.I. 0.201 – 0.953, P = 0.037). The association remained statistically significant after adjustment for traditional cardiovascular risk factors. Diastolic orthostatic hypotension (n = 31) had no impact on the cardiovascular prognosis, but was associated with increased arterial stiffness and increased carotid intima-media thickness at base-line. Systolic orthostatic hypertension (n = 45) had no impact on the risk of cardiovascular events, but was associated with increased arterial stiffness at base-line. Systolic orthostatic hypotension (n = 24) had no impact on cardiovascular prognosis and was not associated with markers of cardiovascular organ damage.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.