Orthostatic Hypotension with Supine Hypertension Revealing Diabetic Cardiac Autonomic Neuropathy: A Case Report and Therapeutic Challenge

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.