QINGBO ZHANG

Diabetic orthostatic hypotension, associated with cardiovascular autonomic neuropathy, can be assessed using the coefficient of variation of the R-R interval (CVRR). We investigated whether CVRR during deep breathing could serve as a risk indicator for orthostatic blood pressure decline in patients with type 2 diabetes. This study included 88 hospitalized patients aged 51.5–71.4 years with type 2 diabetes undergoing diabetes education or glycemic control. Blood pressure changes during postural transitions were measured using a non-invasive beat-to-beat blood pressure monitoring device. Participants were divided into two groups based on CVRR values measured at rest and during deep breathing, using a cutoff of 2%. Blood pressure changes during postural transitions were compared. At rest, no significant differences in systolic or diastolic blood pressure changes were observed between the autonomic dysfunction group (CVRR ≤ 2%, n=42) and the non-autonomic dysfunction group (CVRR >2%, n=46; p > 0.05). However, during deep breathing, patients with CVRR ≤ 2% (n=20) exhibited significantly greater decreases in systolic blood pressure at 0–30, 31–60, 61–90, 91–120, and 151–180 seconds after standing (p < 0.05). These findings suggest that a CVRR below 2% during deep breathing serves as a risk indicator for orthostatic systolic blood pressure decline in patients with type 2 diabetes.

[Purpose] The aim of this paper was to analyze blood pressure fluctuations during rising motion from the viewpoint of orthostatic hypotension and postprandial hypotension, and to formulate suggestions for nursing activities such as assistance in rising/standing. [Method] A total of 20 healthy adults (aged 39.40±10.33 years) were recruited for the trial and instructed to stand from the supine position at three time points: before a meal and at 60 minutes and 120 minutes after a meal. Blood pressure and blood glucose values were continuously measured during these periods. [Results] At the three time points, blood pressure was significantly higher with drastic fluctuations as the subjects’ motions changed from the supine to sitting positions and then returned quietly to the baseline level after standing. No orthostatic hypotension was found (Steel test). Similarly, no postprandial hypotension was found (Bonferroni test). Also, even if the effects of rising/standing and dietary intake overlap, orthostatic hypotension and postprandial hypotension do not occur. There was no correlation between blood pressure and blood glucose (Pearson test). [Discussion/Conclusion] It was clarified that blood pressure rose during postural changes from the supine to the sitting positions in healthy adults. This finding suggests that nursing assistance should pay close attention at the start of rising/standing motions. Thus, we propose that the risks of hypotension in nursing care are minimal.