Orthostatic hypotension (OH) is associated with hypertension and diabetes mellitus. However, in populations with both hypertension and diabetes, 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 Action to Control Cardiovascular Risk in Diabetes (ACCORD) BP trial, seated BP was measured 3 times, 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, and 48 months. The relationship between OH and clinical outcomes (total and cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, heart failure hospitalization or death and the primary composite outcome of non-fatal myocardial infarction, non-fatal stroke and cardiovascular death) was assessed using proportional hazards analysis. Consensus OH, defined by orthostatic decline in systolic BP ≥20 mm Hg and/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 (HR=1.61, 95% CI 1.11–2.36) and heart failure death/hospitalization (HR=1.85, 95% CI 1.17–2.93), but not with the primary outcome or other prespecified outcomes. In patients with type 2 diabetes and hypertension, OH was common, not associated with intensive versus standard BP treatment goals, and predicted increased mortality and heart failure events.

Background Since the Diabetes Prevention Project (DPP) demonstrated that lifestyle weight-loss interventions can reduce the incidence of diabetes by 58%, several studies have translated the DPP methods to public health–friendly contexts. Although these studies have demonstrated short-term effects, no study to date has examined the impact of a translated DPP intervention on blood glucose and adiposity beyond 12 months of follow-up. Purpose To examine the impact of a 24-month, community-based diabetes prevention program on fasting blood glucose, insulin, insulin resistance as well as body weight, waist circumference, and BMI in the second year of follow-up. Design An RCT comparing a 24-month lifestyle weight-loss program (LWL) to an enhanced usual care condition (UCC) in participants with prediabetes (fasting blood glucose=95–125 mg/dL). Data were collected in 2007–2011; analyses were conducted in 2011–2012. Setting/participants 301 participants with prediabetes were randomized; 261 completed the study. The intervention was held in community-based sites. Intervention The LWL program was led by community health workers and sought to induce 7% weight loss at 6 months that would be maintained over time through decreased caloric intake and increased physical activity. The UCC received two visits with a registered dietitian and a monthly newsletter. Main outcome measures The main measures were fasting blood glucose, insulin, insulin resistance, body weight, waist circumference, and BMI. Results Intent-to-treat analyses of between-group differences in the average of 18- and 24-month measures of outcomes (controlling for baseline values) revealed that the LWL participants experienced greater decreases in fasting glucose (−4.35 mg/dL); insulin (−3.01 μU/ml); insulin resistance (−0.97); body weight (−4.19 kg); waist circumference (−3.23 cm); and BMI (−1.40), all p-values <0.01. Conclusions A diabetes prevention program administered through an existing community-based system and delivered by community health workers is effective at inducing significant long-term reductions in metabolic indicators and adiposity. Trial registration This study is registered at Clinicaltrials.gov NCT00631345.