{"id":"b5e43f2deeb9","type":"article","url":"https://hartvaat.nl/2016/10/01/orthostatische-hypotensie-in-de-accord-bloeddruk-trial-prevalentie-en-klinische-/","title":"Orthostatische hypotensie in de ACCORD bloeddruk-trial: prevalentie en klinische impact","title_en":"Orthostatic Hypotension in the ACCORD (Action to Control Cardiovascular Risk in Diabetes) Blood Pressure Trial: Prevalence, Incidence, and Prognostic Significance.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling","figaro-dkd","obesitas","select-trial","soul-trial","summit-trial","vrouwen"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.116.07474","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.116.07474","authors":["Jerome L Fleg","Gregory W Evans","Karen L Margolis","Joshua Barzilay","Jan N Basile","J Thomas Bigger","Jeffrey A Cutler","Richard Grimm","Carolyn Pedley","Kevin Peterson","Rodica Pop-Busui","JoAnn Sperl-Hillen","William C Cushman"],"significance":6,"published":"2016-10-01","source_date":"2016-10-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/behandeldoelen-bloeddruk/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-diabetes/"],"congress":"","summary_en":"This ACCORD analysis characterized orthostatic hypotension in diabetic patients receiving intensive blood pressure therapy, showing that OH is common and associated with adverse events but does not negate the benefit of intensive treatment.","created":"2026-07-03T10:26:19Z","updated":"2026-07-03T18:38:27Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van orthostatische hypotensie in de ACCORD-trial bij diabetespatiënten. Onderzoekt de prevalentie, incidentie en klinische consequenties van orthostatische hypotensie bij intensieve bloeddrukcontrole.","abstract_original":"Orthostatic hypotension (OH) is associated with hypertension and diabetes mellitus. However, in populations with both hypertension and diabetes mellitus, its prevalence, the effect of intensive versus standard systolic blood pressure (BP) targets on incident OH, and its prognostic significance are unclear. In 4266 participants in the ACCORD (Action to Control Cardiovascular Risk in Diabetes) BP trial, seated BP was measured 3×, followed by readings every minute for 3 minutes after standing. Orthostatic BP change, calculated as the minimum standing minus the mean seated systolic BP and diastolic BP, was assessed at baseline, 12 months, and 48 months. The relationship between OH and clinical outcomes (total and cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, heart failure hospitalization or death and the primary composite outcome of nonfatal myocardial infarction, nonfatal stroke, and cardiovascular death) was assessed using proportional hazards analysis. Consensus OH, defined by orthostatic decline in systolic BP ≥20 mm Hg or diastolic BP ≥10 mm Hg, occurred at ≥1 time point in 20% of participants. Neither age nor systolic BP treatment target (intensive, <120 mm Hg versus standard, <140 mm Hg) was related to OH incidence. Over a median follow-up of 46.9 months, OH was associated with increased risk of total death (hazard ratio, 1.61; 95% confidence interval, 1.11-2.36) and heart failure death/hospitalization (hazard ratio, 1.85, 95% confidence interval, 1.17-2.93), but not with the primary outcome or other prespecified outcomes. In patients with type 2 diabetes mellitus and hypertension, OH was common, not associated with intensive versus standard BP treatment goals, and predicted increased mortality and heart failure events."}