Orthostatic Hypotension, Cardiovascular Outcomes, and Adverse Events: Results From SPRINT

Authors

Stephen P Juraschek
Addison A Taylor
Jackson T Wright
Gregory W Evans
Edgar R Miller
Timothy B Plante
William C Cushman
Tanya R Gure
William E Haley
Imran Moinuddin
John Nord
Suzanne Oparil
Carolyn Pedley
Christianne L Roumie
Jeff Whittle
Alan Wiggers
Ciarán Finucane
Rose Anne Kenny
Lawrence J Appel
Raymond R Townsend

Publication Date

3-1-2020

Journal

Hypertension

DOI

10.1161/HYPERTENSIONAHA.119.14309

PMID

31983312

PMCID

PMC7261502

PubMedCentral® Posted Date

9-1-2020

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes

Keywords

Adult, Aged, Antihypertensive Agents, Asymptomatic Diseases, Blood Pressure, Bradycardia, Cardiovascular Diseases, Comorbidity, Female, Follow-Up Studies, Goals, Humans, Hypertension, Hypotension, Hypotension, Orthostatic, Male, Middle Aged, Proportional Hazards Models, Racial Groups, Renal Insufficiency, Chronic, Risk, orthostatic hypotension, hypertension treatment, trial, fall, cardiovascular disease, syncope, blood pressure

Abstract

Orthostatic hypotension (OH) is frequently observed with hypertension treatment, but its contribution to adverse outcomes is unknown. The Systolic Blood Pressure Intervention Trial (SPRINT) was a randomized trial of adults, age ≥50years at high risk for cardiovascular disease (CVD) with a seated systolic BP (SBP) of 130–180 mmHg and a standing SBP ≥110 mmHg. Participants were randomized to a SBP treatment goal of either <120 mmHg or <140 mmHg. OH was defined as a drop in SBP≥20 or diastolic BP ≥10 mmHg one minute after standing from a seated position. We used Cox models to examine the association of OH with CVD or adverse study events by randomized BP goal. During the follow-up period (median 3years), there were 1,170 (5.7%) instances of OH among those assigned a standard BP goal, and 1,057 (5.0%) among those assigned the intensive BP goal. OH was not associated with higher risk of CVD events (primary outcome: HR 1.06; 95%CI: 0.78,1.44). Moreover, OH was not associated with syncope, electrolyte abnormalities, injurious falls, or acute renal failure. OH was associated with hypotension-related hospitalizations or emergency department visits (HR 1.77; 1.11,2.82) and bradycardia (HR 1.94; 1.19,3.15), but these associations did not differ by BP treatment goal. OH was not associated with a higher risk of CVD events and BP treatment goal had no effect on OH’s association with hypotension and bradycardia. Symptomless OH during hypertension treatment should not be viewed as a reason to down-titrate therapy even in the setting of a lower BP goal.

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