Association of Orthostatic Hypotension Timing With Clinical Events in Adults With Diabetes and Hypertension: Results From the ACCORD Trial.
Association of Orthostatic Hypotension Timing With Clinical Events in Adults With Diabetes and Hypertension: Results From the ACCORD Trial.
复制标题
成人糖尿病和高血压患者体位性低血压发生时间与临床事件的关联：ACCORD 试验结果。
DOI：
10.1093/ajh/hpz015
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发表时间：
2019
影响因子：
3.2
通讯作者：
Mukamal,KennethJ
中科院分区：
文献类型：
--
作者：
Juraschek,StephenP;Lipsitz,LewisA;Beach,JenniferL;Mukamal,KennethJ
目的 确定体位性低血压 (OH) 测量时机对其与头晕、跌倒、骨折、心血管疾病 (CVD) 和死亡率之间关系的影响。方法我们分析了糖尿病血压试验中控制心血管风险的行动中的 OH 测量值，该试验评估了两个血压 (BP) 目标（收缩压 [SBP] < 120 mm Hg） 与 SBP < 140 mm Hg）和成人糖尿病和高血压患者的 CVD 事件相比。在基线和随访（12 个月、48 个月和退出）休息 5 分钟后测量坐位血压。站立后连续测量站立血压3次（M1-M3），从1分钟开始，每次测量间隔1分钟。共识 OH 定义为 SBP 下降 ≥ 20 mm Hg 或舒张压 (DBP) 下降 ≥ 10 mm Hg。参与者被询问了直立性头晕、近期跌倒和近期骨折情况，并接受了 CVD 事件和全因死亡率监测。 结果 在 8,450 次就诊中，有 4,268 名参与者接受了 OH 评估（平均年龄 62.6 岁 [SD = 6.6]；46.6% 为女性；22.3% 为黑人）。尽管共识 OH 的所有测量值都与头晕显着相关，但没有一个与跌倒相关，只有 M2（约 3 分钟）与骨折显着相关。没有测量与 CVD 事件相关，但后来的测量与死亡率显着相关。无论时间如何，血压治疗目标都不会增加 OH 的风险。 M1-M3 的平均值或最小值并没有始终如一地改善相关性。 结论 在患有高血压和糖尿病的成人人群中，单次测量或一组测量在结果方面都没有明显优越性。这些发现支持在临床实践中使用灵活定时的单次测量来评估 OH。临床试验注册试验号 NCT00000620
OBJECTIVETo determine the effects of orthostatic hypotension (OH) measurement timing on its associations with dizziness, falls, fractures, cardiovascular disease (CVD), and mortality.METHODSWe analyzed OH measurements from the Action to Control Cardiovascular Risk in Diabetes BP trial, which evaluated two blood pressure (BP) goals (systolic BP [SBP] < 120 mm Hg vs. SBP < 140 mm Hg) and incident CVD among adults with diabetes and hypertension. Seated BP was measured after 5 minutes of rest at baseline and follow-up visits (12 months, 48 months, and exit). Standing BP was measured 3 consecutive times (M1–M3) after standing, starting at 1 minute with each measurement separated by 1 minute. Consensus OH was defined as a drop in SBP ≥ 20 mm Hg or diastolic BP (DBP) ≥ 10 mm Hg. Participants were asked about orthostatic dizziness, recent falls, and recent fractures, and underwent surveillance for CVD events and all-cause mortality.RESULTSThere were 4,268 participants with OH assessments over 8,450 visits (mean age 62.6 years [SD = 6.6]; 46.6% female; 22.3% black). Although all measures of consensus OH were significantly associated with dizziness, none were associated with falls, and only M2 (~3 minutes) was significantly associated with fractures. No measurements were associated with CVD events, but later measurements were significantly associated with mortality. BP treatment goal did not increase risk of OH regardless of timing. Associations were not consistently improved by the mean or minimum of M1–M3.CONCLUSIONIn this population of adults with hypertension and diabetes, neither single time nor set of measurements were clearly superior with regard to outcomes. These findings support the use of a flexibly timed, single measurement to assess OH in clinical practice.CLINICAL TRIALS REGISTRATIONTrial Number NCT00000620