Syncope, Hypotension, and Falls in the Treatment of Hypertension: Results from the Randomized Clinical Systolic Blood Pressure Intervention Trial

Sink, Kaycee M.; Evans, Gregory W.; Shorr, Ronald I.; Bates, Jeffrey T.; Berlowitz, Dan R.; Conroy, Molly B.; Felton, Deborah; Gure, Tanya R.; Johnson, Karen C.; Kitzman, Dalane W.; Lyles, Mary F.; Servilla, Karen S.; Supiano, Mark A.; Whittle, Jeff; Wiggers, Alan; Fine, Lawrence J.

doi:10.1111/jgs.15236

Cited by 75 publications

(73 citation statements)

References 19 publications

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“…Finucane et al also found a 40% increased risk of falls at 2 years of follow‐up in people with orthostatic hypotension in a population‐based prospective study in Irish adults . The SPRINT study also supported this finding, as did smaller and cross‐sectional studies, although one moderately large prospective study did not …”

Section: Discussionmentioning

confidence: 85%

Hypertension Treatment and Control and Risk of Falls in Older Women

Margolis

Buchner

LaMonte

et al. 2019

J American Geriatrics Society

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BACKGROUND/OBJECTIVES A lower risk of falls is commonly cited as a reason to treat hypertension conservatively in older individuals. We examined the effect of hypertension treatment and control status and measured blood pressure (BP) level on the risk of falls in older women. DESIGN/SETTING Prospective cohort study. PARTICIPANTS A total of 5971 women (mean age 79 years; 50.4% white, 33.1% black, 16.5% Hispanic/Latina) enrolled in the Women's Health Initiative and Objective Physical Activity and Cardiovascular Health study. MEASUREMENTS BP was measured by trained nurses, and hypertension treatment was assessed by medication inventory. Participants mailed in monthly calendars to self‐report falls for 1 year. RESULTS Overall, 70% of women had hypertension at baseline (53% treated and controlled, 12% treated and uncontrolled, 5% untreated). There were 2582 women (43%) who reported falls in the 1 year of surveillance. Compared with nonhypertensive women, when adjusted for fall risk factors and lower limb physical function, the incidence rate ratio (IRR) for falls was 0.82 (confidence interval [CI] = 0.74‐0.92) in women with treated controlled hypertension (p = .0008) and 0.73 (CI = 0.62‐0.87) in women with treated uncontrolled hypertension (p = .0004). Neither measured systolic nor diastolic BP was associated with falls in the overall cohort. In women treated with antihypertensive medication, higher diastolic BP was associated with a lower risk of falls in a model adjusted for fall risk factors (IRR = 0.993 per mm Hg; 95% CI = 0.987‐1.000; p = .04). The only class of antihypertensive medication associated with an increased risk of falls compared with all other types of antihypertensive drugs was β‐blockers. CONCLUSION Women in this long‐term research study with treated hypertension had a lower risk of falls compared with nonhypertensive women. Diastolic BP (but not systolic BP) is weakly associated with fall risk in women on antihypertensive treatment (<1% decrease in risk per mm Hg increase). J Am Geriatr Soc, 2019. J Am Geriatr Soc 67:726–733, 2019.

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Section: Discussionmentioning

confidence: 85%

Hypertension Treatment and Control and Risk of Falls in Older Women

Margolis

Buchner

LaMonte

et al. 2019

J American Geriatrics Society

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“…For this analysis, the final date of follow-up was July 22, 2018. Adverse events during the intervention phase of the trial have been publishedpreviously 13,14,28 ; additional adverse event data were not collected during the extended follow-up visits.…”

Section: Methodsmentioning

confidence: 99%

Effect of Intensive vs Standard Blood Pressure Control on Probable Dementia

Williamson

Pajewski

Auchus

et al. 2019

JAMA

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IMPORTANCE There are currently no proven treatments to reduce the risk of mild cognitive impairment and dementia. OBJECTIVE To evaluate the effect of intensive blood pressure control on risk of dementia. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial conducted at 102 sites in the United States and Puerto Rico among adults aged 50 years or older with hypertension but without diabetes or history of stroke. Randomization began on November 8, 2010. The trial was stopped early for benefit on its primary outcome (a composite of cardiovascular events) and all-cause mortality on August 20,2015. The final date for follow-up of cognitive outcomes was July 22, 2018. INTERVENTIONS Participants were randomized to a systolic blood pressure goal of either less than 120 mm Hg (intensive treatment group; n = 4678) or less than 140 mm Hg (standard treatment group; n = 4683). MAIN OUTCOMES AND MEASURES The primary cognitive outcome was occurrence of adjudicated probable dementia. Secondary cognitive outcomes included adjudicated mild cognitive impairment and a composite outcome of mild cognitive impairment or probable dementia. RESULTS Among 9361 randomized participants (mean age, 67.9 years; 3332 women [35.6%]), 8563 (91.5%) completed at least 1 follow-up cognitive assessment. The median intervention period was 3.34 years. During a total median follow-up of 5.11 years, adjudicated probable dementia occurred in 149 participants in the intensive treatment group vs 176 in the standard treatment group (7.2 vs 8.6 cases per 1000 person-years; hazard ratio [HR], 0.83; 95% CI, 0.67–1.04). Intensive BP control significantly reduced the risk of mild cognitive impairment (14.6 vs 18.3 cases per 1000 person-years; HR, 0.81; 95% CI, 0.69–0.95) and the combined rate of mild cognitive impairment or probable dementia (20.2 vs 24.1 cases per 1000 person-years; HR, 0.85; 95% CI, 0.74–0.97). CONCLUSIONS AND RELEVANCE Among ambulatory adults with hypertension, treating to a systolic blood pressure goal of less than 120 mm Hg compared with a goal of less than 140 mm Hg did not result in a significant reduction in the risk of probable dementia. Because of early study termination and fewer than expected cases of dementia, the study may have been underpowered for this end point.

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“…In both SPRINT and the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, intensive therapy was not associated with meaningful changes in health‐related quality of life . As with other clinical trials, the lower blood pressure target in SPRINT was unaccompanied by increases in injurious falls …”

Section: Discussionmentioning

confidence: 95%

“…FSE was measured at baseline, 6 months, 1 year, and annually thereafter until study end. Information on the occurrence of injurious falls was collected quarterly and in the reporting of serious adverse events …”

Section: Methodsmentioning

confidence: 99%

Impact of Intensive Blood Pressure Therapy on Concern about Falling: Longitudinal Results from the Systolic Blood Pressure Intervention Trial (SPRINT)

Berlowitz

Foy

Conroy

et al. 2019

J American Geriatrics Society

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OBJECTIVES Concern about falling is common among older hypertension patients and could impact decisions to intensify blood pressure therapy. Our aim was to determine whether intensive therapy targeting a systolic blood pressure (SBP) of 120 mm Hg is associated with greater changes in concern about falling when compared with standard therapy targeting an SBP of 140 mm Hg. DESIGN Subsample analysis of participants randomized to either intensive or standard therapy in the Systolic Blood Pressure Intervention Trial (SPRINT). SETTING Approximately 100 outpatient sites. PARTICIPANTS A total of 2313 enrollees in SPRINT; participants were all age 50 or older (mean = 69 y) and diagnosed with hypertension. MEASUREMENTS Concern about falling was described by the shortened version of the Falls Efficacy Scale International as measured at baseline, 6 months, 1 year, and annually thereafter. RESULTS Concern about falling showed a small but significant increase over time among all hypertension patients. No differences were noted, however, among those randomized to intensive vs standard therapy (P = .95). Among participants younger than 75 years, no increase in concern about falling over time was noted, but among participants aged 75 years and older, the mean falls self‐efficacy score increased by .3 points per year (P < .0001). No differences were observed between the intensive and standard treatment groups when stratified by age (P = .55). CONCLUSION Intensive blood pressure therapy is not associated with increased concern about falling among older hypertension patients healthy enough to participate in SPRINT. J Am Geriatr Soc 68:614–618, 2020

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Syncope, Hypotension, and Falls in the Treatment of Hypertension: Results from the Randomized Clinical Systolic Blood Pressure Intervention Trial

Abstract: Participants randomized to intensive SBP control had greater risk of hypotension and possibly syncope, but not falls. The greater risk of developing these events associated with intensive treatment did not vary according to age.

Cited by 75 publications

References 19 publications

Hypertension Treatment and Control and Risk of Falls in Older Women

Hypertension Treatment and Control and Risk of Falls in Older Women

Effect of Intensive vs Standard Blood Pressure Control on Probable Dementia

Impact of Intensive Blood Pressure Therapy on Concern about Falling: Longitudinal Results from the Systolic Blood Pressure Intervention Trial (SPRINT)

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