Postural changes in blood pressure among patients with diabetes attending a referral hospital in southwestern Uganda: a cross‑sectional study
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Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
BMC Cardiovascular Disorders
Abstract
Orthostatic hypotension (OH) and orthostatic hypertension (OHT) are often unrecognized in clinical
care for diabetic individuals, yet they are associated with increased risk for adverse cardiovascular outcomes. We
aimed to determine the prevalence of the abnormal orthostatic blood pressure (BP) responses, and associated factors
among diabetic individuals in ambulatory care for diabetes in southwestern Uganda.
Methods: We conducted a cross-sectional study among diabetic individuals aged 18–65 years at Mbarara Regional
Referral Hospital, southwestern Uganda from November 2018 to April 2019. We obtained demographic and clinical
data including a detailed medical history, and glycemic profile. BP measurements were taken in supine position
and within 3 min of standing. We defined OH in participants with either ≥ 20 mmHg drop in systolic BP (SBP)
or ≥ 10 mmHg drop in diastolic BP (DBP) after assuming an upright position. OHT was defined in participants with
either a ≥ 20 mmHg rise in SBP, or ≥ 10 mmHg rise in DBP after assuming an upright position. Multivariate logistic
regression was used to identify factors associated with OH and OHT.
Results: We enrolled 299 participants, with a mean age of 50 years (SD ± 9.8), and mean HbA1c of 9.7% (SD ± 2.6);
70% were female. Of the 299 participants, 52 (17.4%; 95% CI 13.3–22.2%) met the definition of OH and 43 (14.4%; 95%
CI 10.6–18.9%) were classified as having OHT. In multivariable models, factors associated with diabetic OH were older
age (OR = 2.40 for 51–65 years vs 18–50 years, 95% CI 1.02–5.67, P = 0.046), diabetic retinopathy (OR = 2.51; 95% CI
1.14–5.53, P = 0.022), higher resting SBP ≥ 140 mmHg (OR = 3.14; 95% CI 1.31–8.7.56, P = 0.011), and history of palpitations
(OR = 2.31; 95% CI 1.08–4.92, P = 0.031). Self-report of palpitations (OR = 3.14; 95% CI 1.42–6.95, P = 0.005),
and higher resting SBP ≥ 140 mmHg (OR = 22.01; 95% CI 1.10–4.42, P = 0.043) were associated with OHT.
Conclusion: OH and OHT are common among diabetic individuals in ambulatory diabetes care in southwestern
Uganda. Orthostatic BP measurements should be considered as part of routine physical examination to improve
detection of OH and OHT, especially among older diabetics with complications of the disease. Future studies to assess
the health and prognostic implications of OH and OHT among diabetics in the region are warranted.
Description
Keywords
Orthostatic hypotension, Orthostatic hypertension, Diabetes
Citation
Migisha, R., Agaba, D. C., Katamba, G., Manne-Goehler, J., Muyingo, A., & Siedner, M. J. (2021). Postural changes in blood pressure among patients with diabetes attending a referral hospital in southwestern Uganda: a cross-sectional study. BMC Cardiovascular Disorders, 21(1), 1-9. https://doi.org/10.1186/s12872-021-02022-5