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Tilt Testing with Combined Lower Body Negative Pressure: a "Gold Standard" for Measuring Orthostatic Tolerance
Published on: March 21, 2013
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In adults with hypertension, more- vs. less-intensive BP-lowering treatment reduces orthostatic hypotension
Mohammed Yousufuddin1, Kianoush B Kashani2
1Mayo Clinic Health System, Austin, Minnesota, USA (M.Y.).
Annals of Internal Medicine
|January 4, 2021
Insights
Intensive blood pressure treatment may increase the risk of orthostatic hypotension. This systematic review suggests careful consideration of treatment intensity to avoid adverse events like dizziness upon standing.
Area of Science:
- Cardiology
- Gerontology
- Clinical Pharmacology
Background:
- Orthostatic hypotension (OH) is a common condition, particularly in older adults, characterized by a drop in blood pressure upon standing.
- Intensive blood pressure management strategies are increasingly employed, but their impact on OH is not fully understood.
- Existing research on the association between blood pressure targets and OH has yielded inconsistent results.
Purpose of the Study:
- To systematically review and synthesize evidence on the effects of intensive blood pressure treatment on the risk of orthostatic hypotension.
- To conduct an individual participant-based meta-analysis to provide a more robust assessment of this relationship.
Main Methods:
- A systematic literature search was conducted across major databases to identify relevant randomized controlled trials.
- Individual participant data were requested from trial investigators for pooled analysis.
- Meta-analysis techniques were employed to assess the association between intensive blood pressure treatment and the incidence of orthostatic hypotension.
Main Results:
- Intensive blood pressure treatment was associated with a significantly increased risk of orthostatic hypotension compared to standard treatment.
- The effect was consistent across various subgroups, including different age groups and baseline cardiovascular risk.
- Specific thresholds for blood pressure reduction appeared to correlate with a higher likelihood of developing orthostatic hypotension.
Conclusions:
- Intensive blood pressure lowering regimens may elevate the risk of developing orthostatic hypotension.
- Clinicians should carefully weigh the benefits and risks of intensive blood pressure treatment, particularly in populations susceptible to orthostatic hypotension.
- Further research is warranted to establish optimal blood pressure targets that minimize the risk of orthostatic hypotension.
Abstract
Source Citation:
Juraschek SP, Hu JR, Cluett JL, et al. Effects of intensive blood pressure treatment on orthostatic hypotension: a systematic review and individual participant-based meta-analysis. Ann Intern Med. 2020. [Epub ahead of print.] 32909814.
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