Orthostatic hypotension ‘common’ in diabetes, hypertension patients
medwireNews: Orthostatic hypotension occurs in a “relatively high” proportion of hypertensive individuals with Type 2 diabetes and is associated with adverse prognosis, say the ACCORD blood pressure (BP) trial investigators.
However, orthostatic hypotension was not related to BP treatment goals, a finding they find “reassuring”.
The ACCORD BP trial assessed outcomes in 4733 patients randomly assigned to either intensive or standard (systolic BP <120 or 140 mmHg, respectively) BP control.
The current study, published in Hypertension, included 4266 ACCORD BP participants who underwent an orthostatic BP assessment at one or more timepoints (baseline, 12 and 48 months). For these individuals, seated BP was measured three times at 1-minute intervals followed by a similar assessment of standing BP, and orthostatic BP change was calculated as the minimum standing minus the mean seated systolic and diastolic BP.
Twenty percent of patients experienced orthostatic hypotension (defined as a reduction in systolic BP ≥20 mmHg or diastolic BP ≥10 mmHg) on at least one visit, with rates of 17.8%, 10.4% and 12.8% at baseline, 12 and 48 months, respectively.
Of note, the aggressive and standard treatment arms did not differ significantly with respect to the incidence, prevalence or resolution of orthostatic hypotension. This suggests that a lower BP can be targeted in diabetes patients with a high risk of stroke, say Jerome Fleg (National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA) and colleagues.
Individuals with orthostatic hypotension had a significantly increased risk of total mortality and heart failure-related death or hospitalisation than those without, at hazard ratios of 1.62 and 1.85, respectively. But the risk of nonfatal myocardial infarction, stroke, cardiovascular mortality or their composite was not elevated in patients with versus without orthostatic hypotension.
Furthermore, multivariate analysis showed that female gender, high systolic BP and glycated haemoglobin, current smoking status, and use of β blockers, α blockers and insulin predicted an increased probability of orthostatic hypotension, while being of Black ethnicity reduced its likelihood.
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