A 74-year-old man comes to the physician for follow-up of type 2 diabetes mellitus. His diabetes is managed with diet and metformin, and he has shown good compliance with medical visits. The patient has no history of chest pain, dyspnea, lightheadedness, syncope, or falls. He does not use tobacco, alcohol, or illicit drugs.
Blood pressure and pulse are 145/75 mm Hg and 67/min while supine, and 122/64 mm Hg and 72/min after standing for 2 minutes. Physical examination is otherwise unremarkable. His last HbA1c was 7% and creatinine was 0.8 mg/dL. The postural blood pressure changes are reproduced during the subsequent visit, but the patient consistently reports no symptoms.
This patient has an elevated risk for which of the following?

Question

A 74-year-old man comes to the physician for follow-up of type 2 diabetes mellitus.  His diabetes is managed with diet and metformin, and he has shown good compliance with medical visits.  The patient has no history of chest pain, dyspnea, lightheadedness, syncope, or falls.  He does not use tobacco, alcohol, or illicit drugs.
Blood pressure and pulse are 145/75 mm Hg and 67/min while supine, and 122/64 mm Hg and 72/min after standing for 2 minutes.  Physical examination is otherwise unremarkable.  His last HbA1c was 7% and creatinine was 0.8 mg/dL.  The postural blood pressure changes are reproduced during the subsequent visit, but the patient consistently reports no symptoms.
This patient has an elevated risk for which of the following?

Quizplus · Accepted Answer

Orthostatic (postural) hypotension (OH) is defined as a drop in systolic blood pressure >20 mm Hg or in diastolic blood pressure >10 mm Hg within 2-5 minutes of standing from a supine position. It is more common in the elderly and is often seen in patients with volume depletion (hypovolemia due to hemorrhage, hyperglycemia, or diuretics), medication side effect (vasodilators, adrenergic blocking agents), or autonomic dysfunction (Parkinson disease, Lewy body dementia). Orthostatic (postural) hypotension OH is associated with an increased risk of recurrent falls and decline in cognitive function in older individuals. In several population-based studies, symptomatic and asymptomatic OH have each been found to be an independent risk factor for cardiovascular disease and all-cause mortality. (Choice A) Risk factors associated with abdominal aortic aneurysm (AAA) include male sex, advancing age, history of smoking, hypertension, and systemic atherosclerosis. OH is not an independent risk factor for AAA. (Choice C) Risk factors for chronic venous insufficiency include advanced age, prolonged standing, obesity, smoking, pregnancy, prior venous thrombosis, and family history of venous disease. OH is not associated with increased risk of venous insufficiency. (Choice D) Parkinson disease is characterized by progressive motor dysfunction and varying degrees of autonomic failure, which can lead to or worsen OH. In some reports, OH has been linked to cognitive decline or dementia; however, it does not increase the risk of developing Parkinson disease. (Choice E) There is no association between OH and the risk of subarachnoid bleeding. Educational objective: Orthostatic hypotension is associated with an increased risk of cardiovascular disease and all-cause mortality. __________ References: Orthostatic hypotension and mortality risk: a meta-analysis of cohort studies. (http://www.ncbi.nlm.nih.gov/pubmed/23878177) Orthostatic hypotension predicts all-cause mortality and coronary events in middle-aged individuals (The Malmo Preventive Project). (http://www.ncbi.nlm.nih.gov/pubmed/19696189)

A 74-Year-Old Man Comes to the Physician for Follow-Up of Type