title: Orthostatic hypotension is associated with more severe hypertension in elderly autonomous diabetic patients from the French Gerodiab study at inclusion.
abstract: Orthostatic hypotension (OH) has deleterious effects on patients' cardiovascular prognoses. The combination of increased age and diabetes adds to the risk of OH. The aim of the study was to describe the elderly diabetic population relative to the degree of hypertension, the occurrence of complications, medications and cognitive function.
  
  
  METHODS
  In the Gerodiab study (a 5-year French multicentre, prospective, observational study), a total of 987 type 2 diabetic autonomous patients, aged 77±5 years, were recruited between June 2009 and July 2010. Clinical blood pressure measurements were taken supine and then after 1, 3 and 5minutes in a standing position. OH was defined as a decrease in systolic blood pressure (SBP) of at least 20mmHg and/or a decrease in diastolic blood pressure (DBP) of at least 10mmHg at any of the measurements while standing.
  
  
  RESULTS
  At inclusion 301 (30.5%) patients had OH; SBP and DBP at rest were higher in patients with OH than in those without (146±21/78±11mmHg vs. 138±17/72±10mmHg; P<0.001). Individuals with OH exhibited higher pulse pressure (PP) than individuals without (68±18 vs. 65±15mmHg; P<0.05). A significant increase in waist-to-hip ratio was recorded in those with OH versus patients without (P<0.01). Despite more severe hypertension (SBP>160mmHg at inclusion; P<0.01), no significant difference was recorded in the mean number of antihypertensive drugs (1.7±1.1), or in the class of antihypertensive drugs, including beta-blockers (P=0.19) and diuretics (P=0.84). Patients with OH were more likely to have a history of peripheral arterial disease and amputations (31% vs. 24%, P<0.05, and 3.3% vs. 1.5%, P=0.056). There was no significant association between OH and history of peripheral neuropathy (P=0.37), stroke, heart failure or ischemic heart disease. In multivariate analysis, OH remained associated with severe hypertension (P<0.01), increased waist-to-hip ratio (P<0.05) and amputations (P<0.05).
  
  
  CONCLUSIONS
  About one-third of elderly, autonomous diabetic patients had OH. They had more severe hypertension, with higher SBP, DBP and PP at rest. However, the number of anti-hypertensive drugs did not differ compared to patients without OH. This could reflect the medical teams' fears about intensifying treatment.
authors: Department of Internal Medicine and Hypertension, University Hospital Rangueil, TSA 50032, 31059 Toulouse cedex 9, France. Electronic address: duly-bouhanick.b@chu-toulouse.fr.
authors: B
authors: B
authors: Bouhanick
authors: Department of Internal Medicine and Hypertension, University Hospital Rangueil, TSA 50032, 31059 Toulouse cedex 9, France.
authors: S
authors: S
authors: Meliani
authors: Internal Medicine, Geriatrics and Therapeutics, Saint Julien Hospital, Rouen University Hospital, 76031 Rouen cedex, France.
authors: J
authors: J
authors: Doucet
authors: Endocrinology, Begin Hospital, 69, avenue de Paris, 94160 Saint-Mandé, France.
authors: B
authors: B
authors: Bauduceau
authors: Gerontology, Bicêtre University Hospital, 12, rue Séverine, 94276 Le Kremlin-Bicêtre cedex, France.
authors: C
authors: C
authors: Verny
authors: Department of Internal Medicine and Hypertension, University Hospital Rangueil, TSA 50032, 31059 Toulouse cedex 9, France.
authors: B
authors: B
authors: Chamontin
authors: Diabetology-Endocrinology, Villecresnes Medical Hospital, 8, boulevard Richerand, 94440 Villecresnes, France.
authors: J-P
authors: JP
authors: Le Floch
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D000671:Amputation, Surgical; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure; D001795:Blood Pressure Determination; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D015577:Geriatric Assessment; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology; D007024:Hypotension, Orthostatic / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology; D008297:Male; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012648:Self Care; D049629:Waist-Hip Ratio
chemical_list: D000959:Antihypertensive Agents
keywords: Geriatric tests; HTA du sujet âgé; Hypertension in the elderly; Hypotension orthostatique; Orthostatic hypotension; Tests gériatriques