{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T04:16:56Z","timestamp":1768450616926,"version":"3.49.0"},"reference-count":38,"publisher":"American Diabetes Association","issue":"7","content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2003,7,1]]},"abstract":"<jats:p>OBJECTIVE\u2014Diabetic patients with incapacitating orthostatic hypotension can have either a \u201chyperadrenergic\u201d or \u201chypoadrenergic\u201d presentation. Although the latter is related to overt autonomic neuropathy, the former is proposed to be explained by appropriate autonomic responses. We hypothesize, however, that both conditions are part of a spectrum of autonomic dysfunction.<\/jats:p>\n               <jats:p>RESEARCH DESIGN AND METHODS\u2014We studied 16 consecutive diabetic patients with preserved renal function referred for incapacitating orthostatic hypotension and characterized their autonomic and neurohumoral cardiovascular regulation.<\/jats:p>\n               <jats:p>RESULTS\u2014Six patients had a hyperadrenergic orthostatic response: systolic blood pressure fell 42 \u00b1 15 mmHg, heart rate increased 20 \u00b1 3 bpm, and plasma norepinephrine increased from 340 \u00b1 80 to 910 \u00b1 100 pg\/ml. Ten patients had a hypoadrenergic response: systolic blood pressure fell 78 \u00b1 5 mmHg, heart rate increased only 7 \u00b1 3 bpm, and norepinephrine increased only from 130 \u00b1 28 to 230 \u00b1 40 pg\/ml. Vagal (sinus arrhythmia, Valsalva ratio) and sympathetic (response to hyperventilation, postprandial hypotension) responses were impaired in both groups, but to a greater extent in the hypoadrenergic group. Notwithstanding severe orthostatic hypotension, the postural increase in plasma renin was blunted in both groups, more so in the hypoadrenergic group. Despite preserved renal function, patients had mild anemia due to impaired erythropoietin release, as seen in primary cases of autonomic failure.<\/jats:p>\n               <jats:p>CONCLUSIONS\u2014Our results suggest that diabetic patients presenting with hyperadrenergic orthostatic hypotension have an initial stage of autonomic neuropathy, with overtly abnormal vagal function and early signs of sympathetic impairment. Furthermore, altered renin response can contribute to the patients\u2019 orthostatic hypotension.<\/jats:p>","DOI":"10.2337\/diacare.26.7.2174","type":"journal-article","created":{"date-parts":[[2007,3,5]],"date-time":"2007-03-05T22:51:27Z","timestamp":1173135087000},"page":"2174-2180","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":29,"title":["Spectrum of Autonomic Cardiovascular Neuropathy in Diabetes"],"prefix":"10.2337","volume":"26","author":[{"given":"Giris","family":"Jacob","sequence":"first","affiliation":[{"name":"J. Recanati Autonomic Dysfunction Center, Rambam Medical Center, Haifa, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fernando","family":"Costa","sequence":"additional","affiliation":[{"name":"Departments of Medicine and Pharmacology, Autonomic Dysfunction Center, Vanderbilt University, Nashville, Tennessee"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Italo","family":"Biaggioni","sequence":"additional","affiliation":[{"name":"Departments of Medicine and Pharmacology, Autonomic Dysfunction Center, Vanderbilt University, Nashville, Tennessee"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1167","reference":[{"key":"2022031217222383300_R1","unstructured":"Neill HAW: The epidemiology of diabetic autonomic neuropathy. In Autonomic Failure. 3rd ed. Bannister R, Mathias CJ, Eds. 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