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Relationship between orthostatic blood pressure changes and intensive blood pressure management in patients with

Junyu Pei1,2, Hao Zhang3,4, Yanan Li5

  • 1Department of Cardiovascular Medicine, Central South University, Changsha, Hunan, China.

Heart (British Cardiac Society)
|August 25, 2022
PubMed

Insights

Orthostatic blood pressure changes impact cardiovascular risk. Both decreases in systolic and increases in diastolic pressure were linked to higher major adverse cardiovascular event (MACE) risk, independent of intensive blood pressure management.

Area of Science:

  • Cardiology
  • Hypertension Research
  • Clinical Trials

Background:

  • The Systolic Blood Pressure Intervention Trial (SPRINT) showed intensive blood pressure control reduces cardiovascular risk.
  • Orthostatic hypotension is a known concern, but its association with cardiovascular outcomes requires further investigation.

Purpose of the Study:

  • To evaluate the relationship between baseline orthostatic blood pressure (BP) changes and the occurrence of major adverse cardiovascular events (MACE).

Main Methods:

  • A post hoc analysis of 9329 hypertensive patients from the SPRINT trial was conducted.
  • Orthostatic BP change was defined as the difference between baseline standing and seated systolic or diastolic BP.
  • Patients were randomized to intensive BP control (<120 mm Hg systolic) or standard control.

Main Results:

  • A U-shaped relationship was observed between orthostatic BP changes and MACE risk.
  • Decreased systolic BP and increased diastolic BP upon standing were associated with increased MACE risk.
  • Intensive blood pressure management benefits were consistent across different ranges of orthostatic BP changes.

Conclusions:

  • Orthostatic diastolic blood pressure increase and systolic blood pressure decrease are associated with elevated MACE risk.
  • The findings suggest that monitoring orthostatic BP changes may be important in managing hypertensive patients.
  • Intensive blood pressure management remains effective regardless of baseline orthostatic BP status.
Abstract

Keywords:
hypertension

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