Orthostatic hypotension not a barrier to intensive hypertension treatment, meta-analysis finds
Researchers observed that more intensive blood pressure treatment lowered risk of cardiovascular disease or all-cause mortality regardless of whether patients had orthostatic hypotension.
Asymptomatic orthostatic hypotension or standing hypotension in patients with hypertension should not deter more intensive hypertension treatment, a meta-analysis found.
To determine the effect of a lower blood pressure (BP) treatment goal or active therapy compared to standard BP treatment goal or placebo on cardiovascular disease (CVD) or all-cause mortality, researchers conducted a meta-analysis of individual patient data from nine trials, looking at outcomes of CVD and all-cause mortality. Orthostatic hypotension was defined as a decrease in systolic BP of at least 20 mm Hg and/or diastolic BP of at least 10 mm Hg after changing position from sitting to standing. Standing hypotension was defined as a standing systolic BP of 110 mm Hg or less or standing diastolic BP of 60 mm Hg or less. Results were published Oct. 17 in JAMA.
The researchers followed 29,235 participants for a median of four years: 9% of patients had orthostatic hypotension, and 5% had standing hypotension at baseline. Among those without baseline orthostatic hypotension, more intensive BP treatment or active therapy lowered risk of CVD or all-cause mortality (hazard ratio [HR], 0.81; 95% CI, 0.76 to 0.86). The same effect occurred in patients with baseline orthostatic hypotension (HR, 0.83; 95% CI, 0.70 to 1.00; P=0.68 for interaction of treatment with baseline orthostatic hypotension).
Among those without baseline standing hypotension, more intensive BP treatment or active therapy lowered risk of CVD or all-cause mortality (HR, 0.80; 95% CI, 0.75 to 0.85), and although the effect of intensive or active therapy was not statistically significant for patients with baseline standing hypotension (HR, 0.94; 95% CI, 0.75 to 1.18), the overall effect did not differ significantly by baseline standing hypotension (P=0.16 for interaction).
The study authors concluded that intensive BP therapy lowered CVD and mortality risk with no significant effect modification by whether or not a patient had orthostatic hypotension or standing hypotension.
“These findings do not support current practice guidelines with respect to orthostatic hypotension screening in the context of antihypertensive treatment,” authors wrote. “It is reasonable to adjust antihypertensive agents or other drugs in the presence of symptoms of standing hypotension, but not necessarily to modify intensive BP goals.”