Orthostatic Hypotension in Diabetics in the ACCORD (Action to Control Cardiovascular Risk in Diabetes) Blood Pressure Trial
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See related article, pp 888–895
Orthostatic hypotension (OH) is a reduction of ≥20 mm Hg in systolic blood pressure (SBP) or a reduction of ≥10 mm Hg in diastolic blood pressure within 3 minutes of standing. OH may be caused by an excessive decrease in blood volume when a person is standing or from inadequate compensation for the reduction in cardiac preload associated with standing because of deficient stimulation of cardiopulmonary, aortic, and carotid baroreceptors, which reflexly increase sympathetic activity and decrease parasympathetic activity. OH may be associated with advanced age, diabetes mellitus, hypertension, neurological disorders, and medications such as antihypertensive drugs, antidepressants, anti-parkinsonian drugs, antipsychotics, nitrates, alcohol, cardiovascular disorders, endocrine disorders, dehydration, anemia, bedrest/deconditioning, and other disorders.
All older individuals taking antihypertensive drugs should routinely have blood pressure (BP) measured in the sitting position and within 3 minutes of standing.1 BP should not be measured immediately after eating to avoid postprandial hypotension being confused with OH. Both of these disorders may coexist. Postprandial hypotension is also associated with falls, syncope, coronary events, stroke, and all-cause mortality at long-term follow-up.2
OH may cause postural instability, falls, and syncope.3 OH is also associated with an increased incidence of all-cause mortality, coronary events, heart failure, and stroke.4,5 The prevalence of OH in 12 433 individuals in the Atherosclerosis Risk in Communities study was 4.9%.4 At 6-year mean follow-up, individuals with OH had a 3.49× increased risk of coronary heart disease. After controlling for age, ethnicity, sex, comorbid conditions, and cardiovascular risk factors, the hazard ratio for coronary heart disease was increased by 1.85×.4 A meta-analysis of 13 prospective studies included 121 913 individuals.5 At …