Original articleOrthostatic hypotension is associated with more severe hypertension in elderly autonomous diabetic patients from the French Gerodiab study at inclusionL’hypotension orthostatique est associée à une hypertension artérielle plus sévère pour un traitement antihypertenseur similaire chez les patients diabétiques âgés autonomes à l’inclusion dans l’étude Gerodiab
Introduction
Orthostatic hypotension (OH) is common in the elderly, affecting up to 30% of the general population over 65 years old [1], [2], [3]. Large differences have been reported in its prevalence, ranging from 18% to 60% of people living in institutions [4], [5]. OH may or may not be symptomatic [6]. Various hemodynamic mechanisms underlying orthostatic adjustments have been reported with ageing, including a decline in the efficiency of baroreflexes [7]. OH has deleterious effects on cardiovascular function, leading to an increased incidence of cerebrovascular disease, myocardial infarction and mortality [8].
Diabetes is another well-known condition that causes autonomic failure [9]. Compared with younger diabetic patients, the consequences of diabetes and ageing accumulate in the elderly, and exacerbate degenerative complications and the effects of co-morbidities [10]. Although numerous studies have investigated the macroangiopathic complications in type 2 diabetic patients under the age of 70 years, little is known about elderly diabetic patients, particularly regarding the impact of OH on the occurrence of complications [11]. Additionally, there is no clear data about possible relationships between OH and other geriatric parameters such as cognition, nutrition and mood in elderly diabetic patients.
The purpose of the present study was to assess the prevalence of orthostatic hypotension and its potential associations with the degree of hypertension, diabetic complications and cognitive function in diabetic patients aged 70 years and older from the Gerodiab cohort at inclusion.
Section snippets
Material and methods
The Gerodiab study is a French multicentre, prospective, observational 5-year follow-up study designed to analyze glycemic control, morbidity and mortality in type 2 diabetic patients aged 70 years and older, with relatively preserved autonomy (Activity of Daily Living score > 3/6). Protocol details and a description of the population at inclusion have been published previously [12]. Data collection was primarily based on the patient history, including demographic data, cardiovascular risk
Results
An analysis was done on the baseline data of 987 patients, 52% of whom were women, aged 77 ± 5 years (median: 77 years; range 70–101 years), with diabetes duration of 18 ± 11 years and an HbA1c of 7.6 ± 1.3%.
Discussion
This analysis concerns the baseline data of 987 outpatients with type 2 diabetes, all aged 70 years or older, with relatively preserved autonomy, and who were consecutively included in the Gerodiab prospective cohort. It showed that almost one-third of patients had orthostatic hypotension. The main result concerns the association between OH and severe hypertension, which showed no significant difference in the nature or the number of antihypertensive drugs used.
OH was also associated with
Conclusion
In our analysis concerning the baseline data of 987 outpatients with type 2 diabetes, all aged 70 years or older and with relatively preserved autonomy, about one-third of them had OH. They had more severe hypertension and higher SBP, DBP and pulse pressure at rest, suggesting an association between peripheral vascular disease and OH. However, the nature and the number of anti-hypertensive drugs did not differ between patients with and without OH. This could reflect the medical teams’ fears
Disclosure of interest
The authors declare that they have no conflicts of interest concerning this article.
Acknowledgments
We wish to thank the CRO Umanis (D. Dubois, C. Hilbert, A. Ourliac, D. Boichut) for the data collection and management. The complete list of authors and members of the SFD-SFGG group appears in Appendix A Scientific Committee of the SFD/SFGG Intergroup, Appendix B Study Investigators.
Funding: this work was supported by one grant from the national French Hospital Clinical Research Programme (PHRC; Programme Hospitalier de Recherche Clinique), one grant from the Francophone Society for Diabetes
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