Reappraisal of the diagnostic role of orthostatic hypotension in diabetes

Clin Auton Res. 2009 Feb;19(1):58-64. doi: 10.1007/s10286-009-0517-0. Epub 2009 Feb 7.

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) > or = 30 (30-OH) or > 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 (chi (2) = 30.5, P < 0.0001, and chi (2) = 45.1, P < 0.0001, respectively) and nondipping (chi (2) = 31.7, P < 0.0001, and chi (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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Albuminuria / etiology
  • Blood Pressure
  • Diabetes Mellitus*
  • Diabetic Neuropathies / diagnosis*
  • Female
  • Humans
  • Hypotension, Orthostatic / diagnosis*
  • Male
  • Middle Aged
  • ROC Curve
  • Sensitivity and Specificity