vitamin-b-12 and Hypotension--Orthostatic

Metformin has been shown to have both neuroprotective and neurodegenerative effects. The aim of this study was to investigate the effect of metformin in combination with insulin on cardiovascular autonomic neuropathy (CAN) and distal peripheral neuropathy (DPN) in individuals with type 2 diabetes (T2DM).. The study is a sub-study of the CIMT trial, a randomized placebo-controlled trial with a 2 × 3 factorial design, where 412 patients with T2DM were randomized to 18 months of metformin or placebo in addition to open-labelled insulin. Outcomes were measures of CAN: Changes in heart rate response to deep breathing (beat-to-beat), orthostatic blood pressure (OBP) and heart rate and vibration detection threshold (VDT) as a marker DPN. Serum levels of vitamin B12 and methyl malonic acid (MMA) were analysed.. After 18 months early drop in OBP (30 s after standing) was increased in the metformin group compared to placebo: systolic blood pressure drop increased by 3.4 mmHg (95% CI 0.6; 6.2, p = 0.02) and diastolic blood pressure drop increased by 1.3 mmHg (95% CI 0.3; 2.6, p = 0.045) compared to placebo. Beat-to-beat variation decreased in the metformin group by 1.1 beats per minute (95% CI - 2.4; 0.2, p = 0.10). Metformin treatment did not affect VDT group difference - 0.33 V (95% CI - 1.99; 1.33, p = 0.39) or other outcomes. Changes in B12, MMA and HbA. Eighteen months of metformin treatment in combination with insulin compared with insulin alone increased early drop in OBP indicating an adverse effect of metformin on CAN independent of vitamin B12, MMA HbA

Topics: Aged; Autonomic Nervous System Diseases; Blood Pressure; Diabetes Mellitus, Type 2; Diabetic Neuropathies; Female; Glycated Hemoglobin; Humans; Hypoglycemic Agents; Hypotension, Orthostatic; Insulin; Male; Metformin; Middle Aged; Peripheral Nervous System Diseases; Risk Factors; Standing Position; Vitamin B 12

Orthostatic hypotension (OH) and vitamin B12 deficiency are common disorders in older people. Several case series have reported an association between vitamin B12 deficiency and OH. The effect of vitamin B12 replacement on this dysfunction has not been studied. We prospectively studied responses to head up tilt in patients over 70 years with vitamin B12 deficiency (intervention group) and compared their responses after replacement to those of matched patients with idiopathic OH and normal serum vitamin B12 concentrations (control group). Blood pressure (BP), heart rate (HR) and systemic vascular resistance (SVR) changes during orthostatic stress were evaluated using digital artery photoplethysmography. Eight patients and eight controls were studied. Initial head up tilt produced a mean BP decrease of 44/29 mmHg (s.e.m. 4/4 mmHg) in the intervention group and 33/12 mmHg (s.e.m. 3/2 mmHg) in the control group. Repeat head up tilt 6 months after vitamin B12 replacement produced a mean BP decrease of 15/9 mmHg (s.e.m. 5/2 mmHg) in the intervention group. The mean decrease in the control group was 30/12 mmHg (s.e.m. 2/2 mmHg). The difference in BP decreases between groups was statistically significant for both systolic and diastolic BP (p < 0.001 for both systolic BP and diastolic BP). Mean SVR in the intervention group decreased by 658 dynes/cm5/sec (s.e.m. 74 dynes/cm5/sec) during initial head up tilt. Mean SVR during repeat head up tilt decreased by 79 dynes/cm5/sec (s. e. m. 12 dynes/cm5/sec). Mean SVR in the control group decreased by 158 dynes/cm5/sec (s. e. m. 10 dynes/cm5/sec) during initial head up tilt and by 258 dynes/cm5/sec (s. e. m. 31 dynes/cm5/sec). The difference in SVR changes between groups was statistically significant (p = 0.02). We conclude that replacing vitamin B12 in older patients with vitamin B12 deficiency is associated with improved orthostatic tolerance to head up tilt.

Topics: Aged; Aged, 80 and over; Autonomic Nervous System; Blood Pressure; Case-Control Studies; Female; Heart Rate; Humans; Hypotension, Orthostatic; Male; Prospective Studies; Vascular Resistance; Vitamin B 12; Vitamin B 12 Deficiency

A 90-year-old woman with orthostatic hypotension and near-syncope was found to have a low-normal level of vitamin B(12) and no other medical findings that could explain her orthostasis. Her symptoms responded to vitamin B(12) replacement therapy. This case shows that vitamin B(12) deficiency can induce orthostatic hypotension and syncope that are correctable by vitamin B(12) replacement.

Topics: Aged, 80 and over; Biomarkers; Female; Humans; Hypotension, Orthostatic; Syncope; Treatment Outcome; Vitamin B 12; Vitamin B 12 Deficiency; Vitamins

A 47-year-old man with a known and substituted vitamin B12 deficiency presented with increasing symptoms associated with orthostatic hypotension, neck pain and micturitional and visual disturbances.. Catecholamines were strongly reduced in plasma and urine.. A pure autonomic failure was diagnosed and therapy with fludrocortisone, yohimbine and erythropoetine was started. Symptoms with the exception of micturitional disturbances improved strongly.. Multiple-drug treatment of pure autonomic failure is successful. The prognosis is good.

Topics: Adrenergic alpha-Antagonists; Anemia, Pernicious; Autonomic Nervous System Diseases; Blood Pressure; Catecholamines; Diagnosis, Differential; Drug Therapy, Combination; Erythropoietin; Fludrocortisone; Humans; Hypotension, Orthostatic; Male; Middle Aged; Mineralocorticoids; Neck Pain; Prognosis; Pulse; Urination Disorders; Vision Disorders; Vitamin B 12; Yohimbine

Neurological manifestations of cobalamin deficiency are well known and various. We describe an uncommon clinical setting where major orthostatic hypotension was the primary symptom. Recovery was rapidly and completely stabilized with parenteral cobalamin substitution. There was no clinical or electrophysiological signs of neuropathic disorder. This entity is rare but few cases are described in literature. All of them were reversible with vitamin substitution treatment.

Topics: Aged; Humans; Hypotension, Orthostatic; Male; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Administration, Oral; Antidepressive Agents, Tricyclic; Contraindications; Diabetes Complications; Diabetes Mellitus; Diabetic Neuropathies; Drug Interactions; Humans; Hypoglycemic Agents; Hypotension, Orthostatic; Injections, Subcutaneous; Insulin; Vitamin B 12

Topics: Aged; Anemia, Pernicious; Diabetes Mellitus, Type 2; Humans; Hypotension, Orthostatic; Male; Recurrence; Vitamin B 12

A 69-year-old man complaining of syncope was found to have pernicious anemia and orthostatic hypotension due to autonomic neuropathy. Following vitamin B12 replacement with cyanocobalamin, the blood pressure became normal. To our knowledge, this is the first reported case of neurogenic orthostatic hypotension as the initial feature of vitamin B12 deficiency.

Topics: Aged; Anemia, Pernicious; Humans; Hypotension, Orthostatic; Male; Motor Neurons; Neural Conduction; Vitamin B 12

Topics: Anemia; Anemia, Pernicious; Folic Acid; Hematinics; Humans; Hypotension; Hypotension, Orthostatic; Posture; Vitamin B 12