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Effects of Intensive Blood Pressure Treatment on Orthostatic Hypotension : A Systematic Review and Individual
Stephen P Juraschek1, Jiun-Ruey Hu2, Jennifer L Cluett1
1Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (S.P.J., J.L.C., K.J.M.).
Annals of Internal Medicine
|September 10, 2020
Summary
Intensive blood pressure (BP) lowering treatment reduces the risk of orthostatic hypotension (OH) in adults with hypertension. This finding suggests that OH should not prevent or reduce the intensity of BP-lowering therapy.
Area of Science:
- Cardiology
- Clinical Pharmacology
- Hypertension Management
Background:
- Intensive blood pressure (BP)-lowering treatment is associated with reduced cardiovascular disease risk.
- Concerns exist regarding the potential for intensive BP treatment to induce orthostatic hypotension (OH).
Purpose of the Study:
- To evaluate the impact of intensive BP-lowering treatment on the occurrence of OH in adults diagnosed with hypertension.
Main Methods:
- A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted.
- Included trials involved over 500 hypertensive adults, with treatment durations of at least 6 months.
- OH was defined as a significant drop in BP upon standing; data were extracted from MEDLINE, EMBASE, and Cochrane CENTRAL.
Main Results:
- Five trials focused on BP treatment goals and four on active agents versus placebo.
- Intensive BP treatment was associated with a reduced risk of OH (odds ratio, 0.93; 95% CI, 0.86 to 0.99).
- No significant differences in effect were observed based on pre-existing OH or in sensitivity analyses.
Conclusions:
- Intensive BP-lowering treatment effectively decreases the risk of developing orthostatic hypotension.
- Orthostatic hypotension should not be a deterrent for initiating or continuing intensive BP management in hypertensive patients.
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