Orthostatic hypotension in type 2 diabetes: Prevalence and risk factors

Orthostatic hypotension (OH) is a common, but often overlooked, complication in patients with type 2 diabetes mellitus. The aim of this study was to evaluate the prevalence of OH in patients with type 2 diabetes mellitus and investigate its associations with glycemic control, medication use, and microvascular complications.

This retrospective, cross-sectional study included 155 patients with type 2 diabetes mellitus. OH was defined as a sustained drop in systolic and/or diastolic blood pressure within 3min of standing. Demographic data, laboratory parameters, and medication use were analyzed. Logistic regression models and receiver operating characteristic curve analyses were performed to identify and assess the predictive value of independent predictors of OH.

Patients with OH (23.87%) had significantly higher HbA1c levels and a longer duration of diabetes. OH was significantly more common in patients taking diuretics and sodium-glucose co-transporter-2 (SGLT2) inhibitors. However, no significant association between OH and the use of ACE inhibitors (ACEIs) or angiotensin receptor blockers was observed. OH was significantly associated with diabetic neuropathy and retinopathy, but not with nephropathy. HbA1c was a significant predictor of OH, with an optimal cut-off value of 7.95% (sensitivity: 73%; specificity: 57%).

OH is prevalent in patients with type 2 diabetes mellitus and strongly associated with poor glycemic control, longer diabetes duration, and use of diuretics and SGLT2 inhibitors. Therefore, routine screening for OH in high-risk patients with type 2 diabetes mellitus is recommended. Optimization of glycemic control and careful medication selection may mitigate OH risk.