Evidence map›Paper›PMID 27504006›Full record

Trial reportHypertension (Dallas, Tex. : 1979)2016

Orthostatic Hypotension in the ACCORD (Action to Control Cardiovascular Risk in Diabetes) Blood Pressure Trial: Prevalence, Incidence, and Prognostic Significance.

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 and 3 more

Open access · bronzeAbstract readComparative StudyMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Hypertension (Dallas, Tex. : 1979), 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 66 papers, 9 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
66citing papers in PubMed, 9 pooled it
15.7field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

66 citing papers in PubMed, 9 syntheses or guidelines pooled it, 122 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update.Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists · 2022
    Guideline
  4. Pooled it
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  6. Pooled it
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  9. Pooled it
  10. Trial
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  16. Orthostatic changes in systolic blood pressure among SPRINT participants at baseline.Journal of the American Society of Hypertension : JASH · 2016
    Trial
  17. Article
  18. Article
  19. Article
  20. Article

6 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

13 authors at 6 institutions in 1 country.

Jerome L FlegFrom the National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., J.A.C.); Wake Forest University School of Medicine, Winston-Salem, NC (G.W.E., C.P.); Health Partners Institute for Education and Research, Minneapolis, MN (K.L.M., J.S.-H.); Kaiser Permanente of Georgia, Atlanta (J.B.); Medical University of South Carolina, Charleston (J.N.B.); Columbia University School of Medicine, New York, NY (J.T.B.); Berman Center for Outcomes and Clinical Research, Minneapolis, MN (R.G.); University of Minnesota School of Medicine, Minneapolis (K.P.); University of Michigan School of Medicine, Ann Arbor (R.P.-B.); and Veterans Affairs Medical Center, Memphis, TN (W.C.C.). flegj@nhlbi.nih.gov.
Gregory W EvansFrom the National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., J.A.C.); Wake Forest University School of Medicine, Winston-Salem, NC (G.W.E., C.P.); Health Partners Institute for Education and Research, Minneapolis, MN (K.L.M., J.S.-H.); Kaiser Permanente of Georgia, Atlanta (J.B.); Medical University of South Carolina, Charleston (J.N.B.); Columbia University School of Medicine, New York, NY (J.T.B.); Berman Center for Outcomes and Clinical Research, Minneapolis, MN (R.G.); University of Minnesota School of Medicine, Minneapolis (K.P.); University of Michigan School of Medicine, Ann Arbor (R.P.-B.); and Veterans Affairs Medical Center, Memphis, TN (W.C.C.).
Karen L MargolisFrom the National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., J.A.C.); Wake Forest University School of Medicine, Winston-Salem, NC (G.W.E., C.P.); Health Partners Institute for Education and Research, Minneapolis, MN (K.L.M., J.S.-H.); Kaiser Permanente of Georgia, Atlanta (J.B.); Medical University of South Carolina, Charleston (J.N.B.); Columbia University School of Medicine, New York, NY (J.T.B.); Berman Center for Outcomes and Clinical Research, Minneapolis, MN (R.G.); University of Minnesota School of Medicine, Minneapolis (K.P.); University of Michigan School of Medicine, Ann Arbor (R.P.-B.); and Veterans Affairs Medical Center, Memphis, TN (W.C.C.).
Joshua BarzilayFrom the National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., J.A.C.); Wake Forest University School of Medicine, Winston-Salem, NC (G.W.E., C.P.); Health Partners Institute for Education and Research, Minneapolis, MN (K.L.M., J.S.-H.); Kaiser Permanente of Georgia, Atlanta (J.B.); Medical University of South Carolina, Charleston (J.N.B.); Columbia University School of Medicine, New York, NY (J.T.B.); Berman Center for Outcomes and Clinical Research, Minneapolis, MN (R.G.); University of Minnesota School of Medicine, Minneapolis (K.P.); University of Michigan School of Medicine, Ann Arbor (R.P.-B.); and Veterans Affairs Medical Center, Memphis, TN (W.C.C.).
Jan N BasileFrom the National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., J.A.C.); Wake Forest University School of Medicine, Winston-Salem, NC (G.W.E., C.P.); Health Partners Institute for Education and Research, Minneapolis, MN (K.L.M., J.S.-H.); Kaiser Permanente of Georgia, Atlanta (J.B.); Medical University of South Carolina, Charleston (J.N.B.); Columbia University School of Medicine, New York, NY (J.T.B.); Berman Center for Outcomes and Clinical Research, Minneapolis, MN (R.G.); University of Minnesota School of Medicine, Minneapolis (K.P.); University of Michigan School of Medicine, Ann Arbor (R.P.-B.); and Veterans Affairs Medical Center, Memphis, TN (W.C.C.).
J Thomas BiggerFrom the National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., J.A.C.); Wake Forest University School of Medicine, Winston-Salem, NC (G.W.E., C.P.); Health Partners Institute for Education and Research, Minneapolis, MN (K.L.M., J.S.-H.); Kaiser Permanente of Georgia, Atlanta (J.B.); Medical University of South Carolina, Charleston (J.N.B.); Columbia University School of Medicine, New York, NY (J.T.B.); Berman Center for Outcomes and Clinical Research, Minneapolis, MN (R.G.); University of Minnesota School of Medicine, Minneapolis (K.P.); University of Michigan School of Medicine, Ann Arbor (R.P.-B.); and Veterans Affairs Medical Center, Memphis, TN (W.C.C.).
Jeffrey A CutlerFrom the National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., J.A.C.); Wake Forest University School of Medicine, Winston-Salem, NC (G.W.E., C.P.); Health Partners Institute for Education and Research, Minneapolis, MN (K.L.M., J.S.-H.); Kaiser Permanente of Georgia, Atlanta (J.B.); Medical University of South Carolina, Charleston (J.N.B.); Columbia University School of Medicine, New York, NY (J.T.B.); Berman Center for Outcomes and Clinical Research, Minneapolis, MN (R.G.); University of Minnesota School of Medicine, Minneapolis (K.P.); University of Michigan School of Medicine, Ann Arbor (R.P.-B.); and Veterans Affairs Medical Center, Memphis, TN (W.C.C.).
Richard GrimmFrom the National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., J.A.C.); Wake Forest University School of Medicine, Winston-Salem, NC (G.W.E., C.P.); Health Partners Institute for Education and Research, Minneapolis, MN (K.L.M., J.S.-H.); Kaiser Permanente of Georgia, Atlanta (J.B.); Medical University of South Carolina, Charleston (J.N.B.); Columbia University School of Medicine, New York, NY (J.T.B.); Berman Center for Outcomes and Clinical Research, Minneapolis, MN (R.G.); University of Minnesota School of Medicine, Minneapolis (K.P.); University of Michigan School of Medicine, Ann Arbor (R.P.-B.); and Veterans Affairs Medical Center, Memphis, TN (W.C.C.).
Carolyn PedleyFrom the National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., J.A.C.); Wake Forest University School of Medicine, Winston-Salem, NC (G.W.E., C.P.); Health Partners Institute for Education and Research, Minneapolis, MN (K.L.M., J.S.-H.); Kaiser Permanente of Georgia, Atlanta (J.B.); Medical University of South Carolina, Charleston (J.N.B.); Columbia University School of Medicine, New York, NY (J.T.B.); Berman Center for Outcomes and Clinical Research, Minneapolis, MN (R.G.); University of Minnesota School of Medicine, Minneapolis (K.P.); University of Michigan School of Medicine, Ann Arbor (R.P.-B.); and Veterans Affairs Medical Center, Memphis, TN (W.C.C.).
Kevin PetersonFrom the National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., J.A.C.); Wake Forest University School of Medicine, Winston-Salem, NC (G.W.E., C.P.); Health Partners Institute for Education and Research, Minneapolis, MN (K.L.M., J.S.-H.); Kaiser Permanente of Georgia, Atlanta (J.B.); Medical University of South Carolina, Charleston (J.N.B.); Columbia University School of Medicine, New York, NY (J.T.B.); Berman Center for Outcomes and Clinical Research, Minneapolis, MN (R.G.); University of Minnesota School of Medicine, Minneapolis (K.P.); University of Michigan School of Medicine, Ann Arbor (R.P.-B.); and Veterans Affairs Medical Center, Memphis, TN (W.C.C.).
Rodica Pop-BusuiFrom the National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., J.A.C.); Wake Forest University School of Medicine, Winston-Salem, NC (G.W.E., C.P.); Health Partners Institute for Education and Research, Minneapolis, MN (K.L.M., J.S.-H.); Kaiser Permanente of Georgia, Atlanta (J.B.); Medical University of South Carolina, Charleston (J.N.B.); Columbia University School of Medicine, New York, NY (J.T.B.); Berman Center for Outcomes and Clinical Research, Minneapolis, MN (R.G.); University of Minnesota School of Medicine, Minneapolis (K.P.); University of Michigan School of Medicine, Ann Arbor (R.P.-B.); and Veterans Affairs Medical Center, Memphis, TN (W.C.C.).
JoAnn Sperl-HillenFrom the National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., J.A.C.); Wake Forest University School of Medicine, Winston-Salem, NC (G.W.E., C.P.); Health Partners Institute for Education and Research, Minneapolis, MN (K.L.M., J.S.-H.); Kaiser Permanente of Georgia, Atlanta (J.B.); Medical University of South Carolina, Charleston (J.N.B.); Columbia University School of Medicine, New York, NY (J.T.B.); Berman Center for Outcomes and Clinical Research, Minneapolis, MN (R.G.); University of Minnesota School of Medicine, Minneapolis (K.P.); University of Michigan School of Medicine, Ann Arbor (R.P.-B.); and Veterans Affairs Medical Center, Memphis, TN (W.C.C.).
William C CushmanFrom the National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., J.A.C.); Wake Forest University School of Medicine, Winston-Salem, NC (G.W.E., C.P.); Health Partners Institute for Education and Research, Minneapolis, MN (K.L.M., J.S.-H.); Kaiser Permanente of Georgia, Atlanta (J.B.); Medical University of South Carolina, Charleston (J.N.B.); Columbia University School of Medicine, New York, NY (J.T.B.); Berman Center for Outcomes and Clinical Research, Minneapolis, MN (R.G.); University of Minnesota School of Medicine, Minneapolis (K.P.); University of Michigan School of Medicine, Ann Arbor (R.P.-B.); and Veterans Affairs Medical Center, Memphis, TN (W.C.C.).
Kaiser Permanente · USNational Heart Lung and Blood Institute · USHealthPartners · USMedical University of South Carolina · USUniversity of Minnesota · USBerman Center for Outcomes and Clinical Research · US

Funding

Intramural NIH HHS Z99 HL999999
6 · The paper itself

Abstract

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.

Indexed as

AdultAgedAge DistributionAntihypertensive AgentsBlood Pressure DeterminationCanadaCardiovascular DiseasesComorbidityDiabetes Mellitus, Type 2Double-Blind MethodFemaleHumansHypertensionHypotension, OrthostaticMaleMiddle AgedAntihypertensive Agentscardiovascular diseasesclinical trialsdiabetes mellitushypertensionhypotensionorthostaticrandomizedtype 2

Identifiers

PMID27504006
PMCPMC5016241
OpenAlexW2520285370

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.