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

Reappraisal of the diagnostic role of orthostatic hypotension in diabetes.

Author information

1
Endocrinology, Dept. of Internal Medicine, University of Tor Vergata, Via Montpellier 81, Rome, Italy. vispa@mclink.it

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.

PMID:
19199088
DOI:
10.1007/s10286-009-0517-0
[Indexed for MEDLINE]

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