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Low systolic BP goal after stroke decreases risk for orthostatic hypotension
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Among patients with recent stroke, BP treatment to a target of less than 130 mm Hg systolic reduced orthostatic hypotension compared with treatment to a target of 130 mm Hg to 149 mm Hg systolic, researchers reported that the American Heart Association’s Hypertension Scientific Sessions.
Orthostatic hypotension or low BP after standing up is a risk for falls in this population, according to the researchers.
“Falls can be devastating in this older population,” Stephen Juraschek, MD, PhD, assistant professor of medicine at Harvard Medical School and internal medicine physician at Beth Israel Deaconess Medical Center, said in a press release. “As a result, there is substantial concern about anything that might increase their fall risk. However, our study provides strong evidence that intense blood pressure treatment does not induce orthostatic hypotension or its symptoms.”
The researchers assigned 2,876 adults who had a stroke 6 months prior or less (mean age, 63 years; 37% women; mean number of follow-up visits, 15) to receive BP treatment to a target of less than 130 mm Hg systolic or 130 mm Hg to 149 mm Hg systolic.
At follow-up visits, BP was measured three times while sitting and once after 2 minutes of standing.
The primary outcome was orthostatic hypotension, defined as a drop of at least 20 mm Hg systolic or at least 10 mm Hg diastolic. Secondary outcomes included extreme standing BP values including at least 190 mm Hg systolic, less than 90 mm Hg systolic, at least 110 mm Hg diastolic or less than 40 mm Hg diastolic BP. Patients were also asked if they got lightheaded or dizzy while standing up.
Compared with the standard BP group, the lower-goal group had lower odds of orthostatic hypotension (OR = 0.86; 95% CI, 0.75, 0.99), Juraschek and colleagues found.
The lower-goal group also had higher risk for systolic BP of 90 mm Hg or less (OR = 3.79; 95% CI, 2.35-6.11) and diastolic BP of 40 mm Hg or less (OR = 2.42; 95% CI, 1.41-4.15), and lower risk for systolic BP of at least 190 mm Hg (OR = 0.4; 95% CI, 0.27-0.6) and diastolic BP of at least 110 mm Hg (OR = 0.31; 95% CI, 0.19-0.5) compared with the standard group, according with the researchers.
There were no differences between the groups in self-reported dizziness or lightheadedness. – by Erik Swain
Reference:
Juraschek S, et al. Presentation 103. Presented at: American Heart Association’s Hypertension Scientific Sessions; Sept. 5-8, 2019; New Orleans.
Disclosures: The authors report no relevant financial disclosures.