Effects of Intensive Blood Pressure Treatment on Orthostatic Hypotension : A Systematic Review and Individual Participant-based Meta-analysis

Authors

Stephen P Juraschek
Jiun-Ruey Hu
Jennifer L Cluett
Anthony Ishak
Carol Mita
Lewis A Lipsitz
Lawrence J Appel
Nigel S Beckett
Ruth L Coleman
William C Cushman
Barry R Davis
Greg Grandits
Rury R Holman
Edgar R Miller
Ruth Peters
Jan A Staessen
Addison A Taylor
Lutgarde Thijs
Jackson T Wright
Kenneth J Mukamal

Publication Date

1-1-2021

Journal

Annals of Internal Medicine

DOI

10.7326/M20-4298

PMID

32909814

PMCID

PMC7855528

PubMedCentral® Posted Date

7-1-2022

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes

Keywords

Antihypertensive Agents, Blood Pressure, Blood Pressure Determination, Humans, Hypertension, Hypotension, Orthostatic

Abstract

BACKGROUND: Although intensive blood pressure (BP)-lowering treatment reduces risk for cardiovascular disease, there are concerns that it might cause orthostatic hypotension (OH).

PURPOSE: To examine the effects of intensive BP-lowering treatment on OH in hypertensive adults.

DATA SOURCES: MEDLINE, EMBASE, and Cochrane CENTRAL from inception through 7 October 2019, without language restrictions.

STUDY SELECTION: Randomized trials of BP pharmacologic treatment (more intensive BP goal or active agent) that involved more than 500 adults with hypertension or elevated BP and that were 6 months or longer in duration. Trial comparisons were groups assigned to either less intensive BP goals or placebo, and the outcome was measured OH, defined as a decrease of 20 mm Hg or more in systolic BP or 10 mm Hg or more in diastolic BP after changing position from seated to standing.

DATA EXTRACTION: 2 investigators independently abstracted articles and rated risk of bias.

DATA SYNTHESIS: 5 trials examined BP treatment goals, and 4 examined active agents versus placebo. Trials examining BP treatment goals included 18 466 participants with 127 882 follow-up visits. Trials were open-label, with minimal heterogeneity of effects across trials. Intensive BP treatment lowered risk for OH (odds ratio, 0.93 [95% CI, 0.86 to 0.99]). Effects did not differ by prerandomization OH (

LIMITATIONS: Assessments of OH were done while participants were seated (not supine) and did not include the first minute after standing. Data on falls and syncope were not available.

CONCLUSION: Intensive BP-lowering treatment decreases risk for OH. Orthostatic hypotension, before or in the setting of more intensive BP treatment, should not be viewed as a reason to avoid or de-escalate treatment for hypertension.

PRIMARY FUNDING SOURCE: National Heart, Lung, and Blood Institute, National Institutes of Health. (PROSPERO: CRD42020153753).

Comments

Associated Data