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Reappraisal of the diagnostic role of orthostatic hypotension in diabetes

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Abstract

Objective

Given the controversial aspects of orthostatic hypotension (OH) testing in diabetes, we evaluated the diagnostic role for cardiac autonomic neuropathy (CAN) and for nondipping of OH, defined according to a fall in systolic blood pressure (BP) ≥ 30 (30-OH) or ≥ 20 mmHg (20-OH).

Methods

164 diabetic patients underwent 24 hours BP monitoring, three heart rate cardiovascular tests, and OH test.

Results

Compared to 30 mmHg, the 20 mmHg criterion increased the frequency of OH from 11 to 19.5%. Both 30-OH and 20-OH were associated with CAN (χ 2 = 30.5, P < 0.0001, and χ 2 = 45.1, P < 0.0001, respectively) and nondipping (χ 2 = 31.7, P < 0.0001, and χ 2 = 17.2, P = 0.0001, respectively). ROC curve for orthostatic systolic BP fall provided an AUC of 0.79 ± 0.04 (95% CI 0.70–0.86) for diagnosing CAN and of 0.77 ± 0.05 (95% CI 0.66–0.86) for diagnosing nondipping. Both 30-OH and 20-OH showed a low sensitivity and high specificity for CAN [sensitivity 31%, specificity 98%, Likelihood Ratio for a positive result (LR+) 17.1; and sensitivity 50%, specificity 95%, LR+ 9.3, respectively], and for nondipping (sensitivity 40%, specificity 96%, LR+ 8.9, and sensitivity 47%, specificity 87%, LR+ 3.5, respectively), having 30-OH a higher LR+ in both cases.

Interpretation

OH had only moderate diagnostic accuracy, with high specificity and low sensitivity, for CAN, diagnosed on the basis of heart rate cardiovascular tests, and—as a novel finding—also for nondipping. A different definition of OH did not substantially affect its diagnostic characteristics, with just a slightly greater ability of the 30 mmHg criterion to estimate the probability of CAN and nondipping.

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Acknowledgments

Part of the study was presented at the 42nd Annual Meeting of the EASD, Copenhagen-Malmø, Denmark-Sweden, 14–17 September 2006, and published as an abstract (Diabetologia 49, Suppl 1, A673–674, 2006). The study received a public financial support by Tor Vergata University as an Athaeneum Scientific Project.

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Authors and Affiliations

  1. Endocrinology, Dept. of Internal Medicine, University of Tor Vergata, Via Montpellier, 81, 00133, Rome, Italy

    Vincenza Spallone MD, PhD, Roberto Morganti MD, Tiziana Fedele MD, Cinzia D’Amato MD & Maria Rosaria Maiello MD

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  1. Vincenza Spallone MD, PhD
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  2. Roberto Morganti MD
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  3. Tiziana Fedele MD
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  4. Cinzia D’Amato MD
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  5. Maria Rosaria Maiello MD
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Correspondence to Vincenza Spallone MD, PhD.

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Spallone, V., Morganti, R., Fedele, T. et al. Reappraisal of the diagnostic role of orthostatic hypotension in diabetes. Clin Auton Res 19, 58–64 (2009). https://doi.org/10.1007/s10286-009-0517-0

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