Orthostatic Hypotension with Supine Hypertension Revealing Diabetic Cardiac Autonomic Neuropathy: A Case Report and Therapeutic Challenge
Nafia Chaymaa *
Department of Cardiology, Cheikh Khalifa University Hospital, Casablanca, Morocco.
D. Jama
Department of Cardiology, Cheikh Khalifa University Hospital, Casablanca, Morocco.
G. Benouna
Department of Cardiology, Cheikh Khalifa University Hospital, Casablanca, Morocco.
*Author to whom correspondence should be addressed.
Abstract
Cardiac autonomic neuropathy (CAN) is a frequent yet underdiagnosed complication of diabetes mellitus, associated with increased cardiovascular morbidity and mortality. Orthostatic hypotension (OH) is its most common manifestation and may coexist with supine hypertension (SH), creating a therapeutic dilemma. We report the case of a 62-year-old Moroccan woman with long-standing type 2 diabetes mellitus who presented with dizziness and exertional intolerance. Blood pressure measurements revealed supine hypertension (160/90 mmHg) and orthostatic hypotension (110/70 mmHg upon standing), associated with symptoms. Autonomic testing confirmed cardiac autonomic neuropathy after exclusion of secondary causes. A tailored therapeutic approach combining non-pharmacological measures and nocturnal transdermal nitrates led to significant clinical improvement within one week, with better blood pressure stability. The coexistence of OH and SH in CAN represents a complex clinical entity requiring individualized management and early recognition to improve outcomes.
Keywords: Cardiac autonomic neuropathy, orthostatic hypotension, supine hypertension, diabetes mellitus