Intensive Blood Pressure Control, Falls, and Fractures in Patients with Type 2 Diabetes: The ACCORD Trial

Margolis, Karen L.; Palermo, Lisa; Vittinghoff, Eric; Evans, Gregory W.; Atkinson, Hal H.; Hamilton, Bruce P.; Josse, Robert G.; O’Connor, Patrick J.; Simmons, Debra L.; Tiktin, Margaret; Schwartz, Ann V.

doi:10.1007/s11606-014-2961-3

Cited by 65 publications

(66 citation statements)

References 58 publications

(54 reference statements)

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“…Moreover, more intensive BP control is not necessarily associated with increased morbidity. (16) Further randomised controlled trials are needed to clarify treatment targets for each component of BP in CKD patients. (5) Another issue with the use of BP targets is the monitoring of BP.…”

Section: Discussionmentioning

confidence: 99%

Blood pressure and antihypertensive medication profile in a multiethnic Asian population of stable chronic kidney disease patients

Teo

Chua

Wong

et al. 2016

smedj

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RESULTS 613 patients (55.1% male; 74.7% Chinese, 6.4% Indian, 11.4% Malay; 35.7% diabetes mellitus) with a mean age of 57.8 ± 14.5 years were recruited. Mean SBP was 139 ± 20 mmHg, DBP was 74 ± 11 mmHg, serum creatinine was 166 ± 115 µmol/L and GFR was 53 ± 32 mL/min/1.73 m 2 . At a lower GFR, SBP increased (p < 0.001), whereas DBP decreased (p = 0.0052). Mean SBP increased in tandem with the number of antihypertensive agents used (p < 0.001), while mean DBP decreased when ≥ 3 antihypertensive agents were used (p = 0.0020).

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Section: Discussionmentioning

confidence: 99%

Blood pressure and antihypertensive medication profile in a multiethnic Asian population of stable chronic kidney disease patients

Teo

Chua

Wong

et al. 2016

smedj

View full text Add to dashboard Cite

show abstract

“…Margolis et al describe results from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) randomized clinical trial. 6 Among a subsample of 3,099 participants with hypertension and diabetes, the incidence of falls was similar in those randomized to a target blood pressure of 120 mmHg compared to a target of 140 mmHg. Moreover, there was a trend for fewer non-spine fractures in those participants receiving more intensive therapy.…”

mentioning

confidence: 97%

Hypertension Treatment and Falls: Should We be Concerned?

Berlowitz

2014

J GEN INTERN MED

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“…A trend toward more faintness and falls was seen with the lower SBP targets in the SHEP and Action to Control Cardiovascular Risk in Diabetes (ACCORD) trials 29 but were not associated with lower BP treatment targets in the JATOS, VALISH, Studio Italiano Sugli Effetti CARDIOvascolari del Controllo della Pressione Arteriosa SIStolica, or Felodipine Event Reduction trials [31][32][33][34] or in the 80-year-old HYVET participants. 19 A recent report from the ACCORD trial, 42 in a cohort with diabetes mellitus and hypertension (mean age >62, 25% African American), found a nonsignificantly lower risk of falls (relative risk (RR) = 0.84, 95% CI = 0.54-1.29, P = .43) and nonspine fracture risk (hazard ratio (HR) = 0.79, 95% CI = 0.62-1.01, P = .06) in those treated to a SBP less than 120 mmHg than in those treated to a SBP less than 140 mmHg. Similar results were observed in another study, the Reasons for Geographic and Racial Differences in Stroke study, 43 which compared individuals (without CVD history) taking antihypertensive medications in three age groups (55-64, 65-74, ≥75) and found no association between SBP (120-139 vs >150 mmHg) and falls in any of the age groups.…”

Section: Evidence Supporting Bp Treatment Targets In Older Individualmentioning

confidence: 99%

Recognition and Management of Hypertension in Older Persons: Focus on African Americans

Still

Ferdinand²,

Ogedegbe

et al. 2015

J American Geriatrics Society

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Multiple clinical trials have demonstrated the beneficial effects of blood pressure (BP) reduction on cardiovascular morbidity and mortality, with most of the evidence in individuals aged 60 and older. Several guidelines have recently been published on the specific management of hypertension in individuals aged 60 and older, including in high-risk groups such as African Americans. Most recommend careful evaluation, thiazide diuretics and calcium-channel blockers for initial drug therapy in most African Americans, and angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in those with chronic kidney disease or heart failure. Among the areas of controversy is the recommended target BP in African Americans aged 60 and older. A recent U.S. guideline recommended raising the systolic BP target from less than 140 mmHg to less than 150 mmHg in this population. This article will review the evidence and current guideline recommendations for hypertension treatment in older African Americans, including the rationale for continuing to recommend a SBP target of less than 140 mmHg in this population.

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Intensive Blood Pressure Control, Falls, and Fractures in Patients with Type 2 Diabetes: The ACCORD Trial

Abstract: We conclude that intensive antihypertensive treatment that lowered mean systolic blood pressure to below 120 mmHg was not associated with an increased risk of falls or non-spine fractures in patients age 40 to 79 years with type 2 diabetes.

Cited by 65 publications

References 58 publications

Blood pressure and antihypertensive medication profile in a multiethnic Asian population of stable chronic kidney disease patients

Blood pressure and antihypertensive medication profile in a multiethnic Asian population of stable chronic kidney disease patients

Hypertension Treatment and Falls: Should We be Concerned?

Recognition and Management of Hypertension in Older Persons: Focus on African Americans

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