Journal of Emergency Practice and Trauma

Orthostatic Hypotension among Vietnamese Older Adults with Type 2 Diabetes And Its Predictors

Document Type : Original Article

Authors

Tuyen Nguyen Thi Thanh 1
Thuy Luu Thi 1
Oanh Tran 2

1 Faculty of Nursing, Da Nang University of Medical Technology and Pharmacy, Da Nang 50000, Vietnam

2 Institute of International Education, Hue University of Medicine and Pharmacy, Hue University, Hue City 49000, Vietnam

https://doi.org/Doi:10.34172/jept.2025.14
Abstract
Objective: Orthostatic hypertension (OH) is one of the most common symptoms of autonomic
nervous system disorder in patients with type 2 diabetes. This study aimed to determine the
percentage of OH among Vietnamese older adults with type 2 diabetes and its influencing factors.
Methods: A cross‐sectional descriptive study was conducted using convenience sampling to recruit
96 older adults with type 2 diabetes who received care at a large hospital in central Vietnam between
November 2020 and June 2021. Data were collected using a demographic and health-related
questionnaire and Omron electronic sphygmomanometers for blood pressure (BP) measurement.
OH was diagnosed according to the 1996 diagnosis criteria of the American Autonomic Society
and the American Academy of Neurology. Descriptive statistics, independent t-test, chi-square,
and univariable and multivariable logistic regression were used for analysis, with p-value≤0.05
considered significant.
Results: The relative frequency of orthostatic hypotension (OH) among older adults with type 2
diabetes was 46.9%. Multivariable logistic regression identified gender, HbA1C level, and duration
of diabetes as significant predictors of OH. Specifically, females had 5.44-fold higher odds of
developing OH compared to males (OR=5.44; 95% CI: 1.94–15.25; P=0.001). Each one-unit increase
in HbA1C was associated with a 1.33-fold increase in the odds of OH (OR=1.33; 95% CI: 1.002–
1.77; P=0.049). Additionally, longer diabetes duration was linked to higher odds of OH, with an
8.3% increase in odds for each additional year of diabetes (OR=1.08; 95% CI: 1.01–1.16; P=0.018).
Although stroke history and kidney failure showed elevated odds ratios, their associations with OH
were not statistically significant (P>0.05).
Conclusion: Orthostatic hypotension (OH) is highly prevalent among older adults with type 2
diabetes, particularly in females with prolonged disease duration and poor glycemic control
(high HbA1C). Clinically, these findings highlight the need for healthcare providers to prioritize
routine screening and tailored management strategies for this high-risk group, aiming to prevent
complications such as falls, cardiovascular events, and decreased quality of life

Keywords

Aged
Hemoglobin A
Glycosylated
Hypotension
Orthostatic
Diabetes mellitus
Type 2
Disease duration
Subjects
1. Fedorowski A, Ricci F, Hamrefors V, Sandau KE, Hwan Chung T, Muldowney JA, et al. Orthostatic hypotension:
management of a complex, but common, medical problem. Circ Arrhythm Electrophysiol. 2022;15(3):e010573. doi:
10.1161/circep.121.010573.
2. Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system
atrophy. The Consensus Committee of the American Autonomic Society and the American Academy of Neurology.
Neurology. 1996;46(5):1470. doi: 10.1212/wnl.46.5.1470.
3. Fleg JL, Evans GW, Margolis KL, Barzilay J, Basile JN, Bigger JT, et al. Orthostatic hypotension in the ACCORD
(Action to Control Cardiovascular Risk in Diabetes) blood pressure trial: prevalence, incidence, and prognostic
significance. Hypertension. 2016;68(4):888-95. doi: 10.1161/hypertensionaha.116.07474.
4. Spallone V. Blood pressure variability and autonomic dysfunction. Curr Diab Rep. 2018;18(12):137. doi: 10.1007/
s11892-018-1108-z.
5. Spallone V. Update on the impact, diagnosis and management of cardiovascular autonomic neuropathy in diabetes: what is defined, what is new, and what is unmet. Diabetes Metab J. 2019;43(1):3-30. doi: 10.4093/dmj.2018.0259.
6. Zhou Y, Ke SJ, Qiu XP, Liu LB. Prevalence, risk factors, and prognosis of orthostatic hypotension in diabetic patients: a
systematic review and meta-analysis. Medicine (Baltimore). 2017;96(36):e8004. doi: 10.1097/md.0000000000008004 .
7. Whitaker AR, Barreto J, Nadruz W, Sposito AC. Orthostatic blood pressure phenotypes prevalence in type 2 diabetes
mellitus. Curr Med Res Opin. 2024;40(11):1833-9. doi:10.1080/03007995.2024.2407537.
8. Idiaquez Rios JF, Lovblom LE, Perkins BA, Bril V. Orthostatic blood pressure changes and diabetes duration. J Diabetes
Complications. 2022;36(5):108169. doi: 10.1016/j.jdiacomp.2022.108169.
9. Quoc NK, Nhi VA. Examine the Mini Mental State Examination (MMSE) on normal cognitive Vietnamese. Tap Chi Y Hoc TP Ho Chi Minh. 2006;9(1).
10. Rivasi G, Rafanelli M, Mossello E, Brignole M, Ungar A. Drugrelated orthostatic hypotension: beyond anti-hypertensive medications. Drugs Aging. 2020;37(10):725-38. doi: 10.1007/s40266-020-00796-5.
11. Bezerra CB, de Carvalho CC, de Lima Saintrain MV, Doucet J. Orthostatic hypotension and associated factors in older adults Brazilian and French with diabetes. Int J Adv Eng Res Sci. 2021;8(1):172-9. doi: 10.22161/ijaers.81.25.
12. Bouhanick B, Meliani S, Doucet J, Bauduceau B, Verny C, Chamontin B, et al. Orthostatic hypotension is associated with more severe hypertension in elderly autonomous diabetic patients from the French Gerodiab study at inclusion. Ann Cardiol Angeiol (Paris). 2014;63(3):176-82. doi: 10.1016/j.ancard.2014.05.013.
13. Wijkman M, Länne T, Östgren CJ, Nystrom FH. Diastolic orthostatic hypertension and cardiovascular prognosis in type 2 diabetes: a prospective cohort study. Cardiovasc Diabetol. 2016;15:83. doi: 10.1186/s12933-016-0399-0.
14. DuPont JJ, Kenney RM, Patel AR, Jaffe IZ. Sex differences in mechanisms of arterial stiffness. Br J Pharmacol.
2019;176(21):4208-25. doi: 10.1111/bph.14624.
15. Fu Q, Ogoh S. Sex differences in baroreflex function in health and disease. J Physiol Sci. 2019;69(6):851-9. doi: 10.1007/s12576-019-00727-z.
16. Zafar U, Rahman SU, Hamid N, Salman H. Assessment of gender differences in autonomic nervous control of the
cardiovascular system. J Pak Med Assoc. 2020;70(9):1554-8. doi: 10.5455/jpma.27702.
17. Bavaria DR, Rathod AV, Patel AS, Chaudhari JB. Orthostatic hypotension and its relationship with HbA1c levels in patients with diabetes mellitus. Natl J Med Res. 2022;12(3):31-4. doi:10.55489/njmr.12032022901.
18. Gannon J, Claffey P, Laird E, Newman L, Kenny RA, Briggs R. The cross-sectional association between diabetes and
orthostatic hypotension in community-dwelling older people. Diabet Med. 2020;37(8):1299-307. doi: 10.1111/dme.14187.
19. Gaspar L, Kruzliak P, Komornikova A, Celecova Z, Krahulec B, Balaz D, et al. Orthostatic hypotension in diabetic
patients-10-year follow-up study. J Diabetes Complications. 2016;30(1):67-71. doi: 10.1016/j.jdiacomp.2015.08.020.
20. Cuspidi C, Gherbesi E, Tadic M. Diabetes and orthostatic hypotension: are all patients created equal? J Hypertens.
2023;41(7):1217-8. doi: 10.1097/hjh.0000000000003432.
21. Iovino M, Triggiani V, Licchelli B, Tafaro E, Giagulli V, Sabbà C, et al. Vasopressin release induced by hypothension is
blunted in patients with diabetic autonomic neuropathy. Immunopharmacol Immunotoxicol. 2011;33(1):224-6. doi:
10.3109/08923971003734054.
22. Fleischer J. Diabetic autonomic imbalance and glycemic variability. J Diabetes Sci Technol. 2012;6(5):1207-15. doi:
10.1177/193229681200600526.
Journal of Emergency Practice and Trauma
Volume 10, Issue 2
July 2024
Pages 137-141

  • Receive Date 07 April 2025
  • Revise Date 07 July 2025
  • Accept Date 02 August 2025

Home

Editor-in-Chief: Shahrad Tajoddini, MD

Guide for Authors

Submit Manuscript

Reviewers

Contact Us

Editorial board