Effects of Intensive Blood Pressure Treatment on Orthostatic Hypotension

Juraschek, Stephen P.; Hu, Jiun-Ruey; Cluett, Jennifer L; Ishak, Anthony; Mita, Carol; Lipsitz, Lewis A.; Appel, Lawrence J.; Beckett, Nigel; Coleman, Ruth L.; Cushman, William C.; Davis, Barry R.; Grandits, Greg; Holman, Rury R.; Miller, Edgar R.; Peters, Ruth; Staessen, Jan A.; Taylor, Addison; Thijs, Lutgarde; Wright, Jackson T.; Mukamal, Kenneth J.

doi:10.7326/m20-4298

Cited by 59 publications

(43 citation statements)

References 38 publications

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“…Another important finding of our study is that an increase in antihypertensive usage was seen, in many cases, with improved morphological patterns and reduced proportions of OI. This is consistent with the findings of a recent systematic review and meta-analysis by Juraschek et al that found that treating hypertension improves orthostatic BP patterns and reduces OH [36]. It is hypothesised that this may be secondary to the improved baroreflex sensitivity [37,38] and cerebral blood flow [39] associated with antihypertensive therapy.…”

Section: Discussionsupporting

confidence: 90%

Eight Orthostatic Haemodynamic Patterns in The Irish Longitudinal Study on Ageing (TILDA): Stability and Clinical Associations after 4 Years

et al. 2021

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Previous research cross-sectionally characterised eight morphological systolic blood pressure (SBP) active stand (AS) patterns using a clinical clustering approach at Wave 1 (W1) of the Irish Longitudinal Study on Ageing. We explored the longitudinal stability and clinical associations of these groupings at Wave 3 (W3), four years later. Eight AS groups had their clinical characteristics and AS patterns at W3 compared to W1. We explored longitudinal associations (new cognitive decline, falls, syncope, disability, and mortality) using multivariate logistic regression models. In total, 2938 participants (60% of Wave 1 sample) had adequate AS data from both W1 and 3 for analysis. We found no longitudinal stability of the eight AS groups or their morphological patterns between the waves. A pattern of impaired stabilisation and late deficit seemed more preserved and was seen in association with new cognitive decline (OR 1.63, 95% CI: 1.12–2.36, p = 0.011). An increase in antihypertensive usage seemed associated with reduced immediate SBP drops, improved AS patterns, and reduced orthostatic intolerance (OI). In pure longitudinal groups, AS patterns were not preserved after 4 years. AS patterns are longitudinally dynamic, and improvements after 4 years are possible even in the presence of higher antihypertensive burden.

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Section: Discussionsupporting

confidence: 90%

Eight Orthostatic Haemodynamic Patterns in The Irish Longitudinal Study on Ageing (TILDA): Stability and Clinical Associations after 4 Years

et al. 2021

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“…20 Nevertheless, in a recent meta-analysis of 9 randomized clinical trials, we showed that intensive BP lowering treatment decreased the risk of OH based on seated-to-standing protocols. 4 However, the question remained whether these studies missed OH elicited from a supine-to-standing protocol. The present study addresses this concern, demonstrating that there was no increased risk of OH from treatment with a number of first-line antihypertensive agents, regardless of protocol used.…”

Section: Discussionmentioning

confidence: 99%

Body Position and Orthostatic Hypotension in Hypertensive Adults: Results from the Syst-Eur Trial

et al. 2023

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BACKGROUND: We recently demonstrated that more intensive blood pressure (BP) treatment lowered risk of orthostatic hypotension (OH) measured with a seated-to-standing protocol. However, seated-to-standing OH assessments are less sensitive than supine-to-standing and could miss clinically relevant OH. OBJECTIVES: Using data from the Syst-Eur trial (Systolic Hypertension in Europe), we examined the effect of hypertension treatment on incidence of OH based on the difference in BP from 3 body positions. METHODS: Syst-Eur was a multi-center, randomized trial that enrolled adults with isolated systolic hypertension to investigate whether active hypertension treatment could reduce cardiovascular events. Participants underwent BP measurement in supine, seated, and standing positions. Using differences in BP between the 3 body positions (seated minus supine, standing minus seated, and standing minus supine), we defined OH as a drop in systolic BP ≥20 mm Hg or diastolic BP ≥10 mm Hg. We included measurements from baseline and follow-up visits. RESULTS: Among 4695 participants (mean age, 70.2±6.7 years; 66.9% female) with 42 636 BP measurements, OH was present in 4.9% of measures with supine-to-seated, 7.9% with seated-to-standing, and 11.4% with supine-to-standing protocols, respectively. Compared with placebo, BP treatment did not increase OH with any set of maneuvers, OR, 0.79 (95% CI, 0.65–0.95) with seated-to standing, 1.03 (95% CI, 0.86–1.24) with supine-to-seated, and 0.99 (95% CI, 0.86–1.15) with supine-to-standing. CONCLUSIONS: Regardless of protocol, active hypertension treatment did not increase the risk of OH, reinforcing evidence that OH should not be viewed as a complication of hypertension treatment. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02088450.

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“…In a large randomised controlled trial, more intensive blood pressure targets (systolic blood pressure ≤120 mm Hg) were not more likely to cause postural hypotension than standard targets (systolic blood pressure ≤140 mm Hg), but syncope was more common 47. A recent systematic review and meta-analysis showed that lower blood pressure treatment goals decreased the risk of postural hypotension 48…”

Section: Special Considerations In Hypertensive Patientsmentioning

confidence: 99%