Orthostatic Blood Pressure Changes and Associated Factors Among Adults With Diabetes in Cameroon: A Cross‐Sectional Study
Clovis Nkoke, Ryan Awa, Denis Teuwafeu, Leslie Tasha Mbapah, Simeon Pierre ChoukemBackground
Orthostatic blood pressure abnormalities are common in people with diabetes mellitus (DM) and are associated with adverse cardiovascular outcomes. Data on orthostatic hypotension (OH), exaggerated orthostatic pressor response (EOPR), and orthostatic hypertension (OHTN) in patients with diabetes from sub‐Saharan Africa are limited.
Methods
We conducted a multicenter cross‐sectional study among 339 ambulatory adults with DM attending three referral hospitals in Cameroon between November 2023 and April 2024. OH, EOPR, and OHTN were defined according to the 2023 American Autonomic Society/Japanese Society of Hypertension consensus statement. Prespecified multivariable logistic regression models identified factors independently associated with OH and OHTN.
Results
The mean age was 60.3 ± 11.3 years, and 66.1% of participants were female. The prevalence of OH was 13.3% (95% CI, 9.8–17.4), EOPR 8.9% (95% CI, 6.1–12.4), and OHTN 8.6% (95% CI, 5.8–12.1). A history of diabetes‐related complications (adjusted odds ratio [aOR] 2.47, 95% CI 1.05–5.81; p = 0.038) and ever smoking (aOR 2.85, 95% CI 1.09–7.44; p = 0.032) were independently associated with OH. Increasing age (aOR 1.08 per year, 95% CI 1.03–1.13; p = 0.002) and dyslipidemia (aOR 2.79, 95% CI 1.11–7.06; p = 0.030) were independently associated with OHTN. Sensitivity analyses using the previous diagnostic criteria increased the estimated prevalence of EOPR to 16.5% and OHTN to 15.0.
Conclusions
Orthostatic blood pressure abnormalities were common among adults with DM in this hospital‐based cohort in Cameroon. OH and OHTN were associated with different clinical factors, suggesting potentially distinct underlying mechanisms. Routine orthostatic blood pressure assessment may provide additional information for cardiovascular risk stratification in adults with diabetes, particularly in resource‐limited settings.