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Severe orthostatic hypotension with diabetic autonomic neuropathy successfully treated with a β1-blocker: a case report

Journal of Human Hypertension volume 20, pages 801–803 (2006)Cite this article

Orthostatic hypotension due to diabetic neuropathy is difficult to manage, because the standing BP should be raised without at the same time raising supine BP. The proposed causes of orthostatic hypotension include damaged sympathetic vasoconstrictor fibres, and impaired baroreceptor function.1 Few papers have described the treatment of diabetic orthostatic hypotension with β-blockers.2 Combined β1 and β2 blockade has been reported to reduce the fall of SBP on standing up, but in one study a cardio-selective β1-blocker was not effective.2 The successful use of a β1-blocker in diabetic orthostatic hypotension has not been reported. β-Blockers have been reported to have paradoxical pressor effects while standing in patients with orthostatic hypotension,3 but they have not been widely used in hypotensive patients because it has also been reported that they can cause congestive heart failure without having pressor effects.4 We here describe a case of severe orthostatic hypotension with diabetic neuropathy successfully treated with a once daily bedtime dose of a β1-blocker.

A 54-year-old man with diabetes was referred to the Hypertension Clinic in Jichi Medical School Hospital with symptoms of dizziness and orthostatic intolerance. In 2002, he started insulin therapy (Hemoglobin A1c 9 %), and in 2004, he was started on a once daily dose of valsartan 80 mg for hypertension. He sometimes complained of dizziness and fainting while standing. On 13 February 2005, he fell down while riding a bicycle. As the clinic BP was 84/60 mm Hg on 14 March, and the valsartan was stopped. He was referred to otolaryngology and neurology, but no significant abnormalities were detected.

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Acknowledgements

This study was supported by the grant from Jichi Medical School Young Investigator award.

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Authors and Affiliations

  1. Columbia University Medical College, Behavioral Cardiovascular Health & Hypertension Program, New York, NY, USA

    K Eguchi & T G Pickering

  2. Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical School, USA

    K Eguchi, J Ishikawa, S Hoshide, T Komori, H Tomizawa, K Shimada & K Kario

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  1. K Eguchi
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  2. T G Pickering
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  3. J Ishikawa
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Eguchi, K., Pickering, T., Ishikawa, J. et al. Severe orthostatic hypotension with diabetic autonomic neuropathy successfully treated with a β1-blocker: a case report. J Hum Hypertens 20, 801–803 (2006). https://doi.org/10.1038/sj.jhh.1002066

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