Association of diabetes, hypertension, and their combination with basal symptoms and treatment responses in overactive bladder patients

Abstract

Introduction: Pelvic hypoperfusion caused by atherosclerosis has been proposed as a cause of lower urinary tract dysfunction including overactive bladder syndrome (OAB). Limited data indicate that OAB patients with concomitant diabetes or hypertension, known risk factors of atherosclerosis, may exhibit greater baseline OAB symptoms and slightly smaller therapeutic responses to treatment, but the impact of a combined presence of diabetes and hypertension has not been reported. Therefore, we have explored whether the combined presence of both comorbidities is associated with greater baseline OAB symptoms than that of either comorbidity alone. Secondary questions were exploration of the impact of either comorbidity on baseline symptoms, and of the impact of either comorbidity alone and their combination on therapeutic responses. Methods: Data from two non-interventional studies applying treatment with propiverine ER 30 or 45 mg/d for 12 weeks were analyzed. Results: Number of urgency episodes in the combination group was greater than with each comorbidity alone. The impact of comorbidities on baseline intensity of incontinence, frequency or nocturia or Patient Perception of Bladder Condition was less consistent or absent. Either comorbidity alone was associated with a smaller % improvement of symptoms, and their combination had a greater effect than either alone. However, all attenuations associated with comorbidity were small relative to the overall improvement. Conclusions: We conclude that comorbidities of diabetes and hypertension have detectable effects on OAB symptoms and treatment responses, but the small magnitude of these alterations does not justify changing existing paradigms for the clinical management of OAB.

Keywords: comorbidity; diabetes; hypertension; non-interventional study; overactive bladder syndrome; propiverine; treatment.

FIGURE 1

Frequency distribution of the PPBC score in study I: (A) across groups at baseline, (B) across groups after 12 weeks of treatment, (C) comparison of baseline and after 12 weeks of treatment in control patients, (D) comparison in diabetic patients, (E) comparison in hypertensive patients, and (F) comparison in patients with both comorbidities.

FIGURE 2

Frequency distribution of PPBC score in study II: (A) across groups at baseline, (B) across groups after 12 weeks of treatment, (C) comparison of baseline and after 12 weeks of treatment in control patients, (D) comparison in diabetic patients, (E) comparison in hypertensive patients, and (F) comparison in patients with both comorbidities.

FIGURE 3

Violin plots of % changes in study I in number of (A) urgency, (B) incontinence, (C) frequency, and (D) nocturia episodes per 24 h. Median and interquartile ranges are indicated by the horizontal solid and dashed lines, respectively, within each plot. Note that only subject with a pathological value at baseline were included a very small number of subjects exhibited a worsening, indicated here as negative value.

FIGURE 4

Violin plots of % changes in study II in number of (A) urgency, (B) incontinence, (C) frequency, and (D) nocturia episodes per 24 h. Median and interquartile ranges are indicated by the horizontal solid and dashed lines, respectively, within each plot. Note that only subject with a pathological value at baseline were included a very small number of subjects exhibited a worsening, indicated here as negative value.