Intensive BP-lowering treatment does not raise risk for orthostatic hypotension
An intensive BP-lowering strategy did not increase risk for extreme drops in BP and should not be avoided due to preexisting orthostatic hypotension, researchers reported.
In this meta-analysis, presented at the American Heart Association Hypertension Scientific Sessions and published in the Annals of Internal Medicine, investigators also found that antihypertensive treatment may reduce the risk for orthostatic hypotension, especially in patients without diabetes.
“Our findings should challenge the traditional teaching about blood pressure treatment causing orthostatic hypotension, reassuring clinicians about the safety of blood pressure treatment with regard to this condition,” Stephen P. Juraschek, MD, PhD, clinician investigator at Beth Israel Deaconess Medical Center and assistant professor of medicine at Harvard Medical School, said in a press release.
The researchers used individual participant data from five randomized clinical trials that evaluated the effect of intensive pharmacologic treatment for hypertension compared with less intensive treatment or placebo to determine whether an intensive strategy was associated with orthostatic hypotension, defined as a drop in systolic BP of 20 mm Hg or more after moving from a seated to a standing position.
The meta-analysis included 18,466 patients and the studies had low heterogeneity (I2 = 0%).
According to the researchers, an intensive BP treatment strategy reduced risk for orthostatic hypertension compared with less intensive pharmacological therapies or placebo (OR = 0.93; 95% CI, 0.86-0.99).
In patients without diabetes, an intensive BP-lowering strategy was associated with lower risk for orthostatic hypotension (OR = 0.9; 95% CI, 0.83-0.98), but the same was not true for patients with diabetes (OR = 1.1; 95% CI, 0.96-1.27; P for interaction = .015), Juraschek and colleagues found.
According to the study, adults with lower standing systolic BP also experienced lower risk for orthostatic hypotension compared with patients with higher standing systolic BP (OR for BP < 110 mm Hg = 0.66; OR for BP 110 mm Hg = 0.96; P for interaction = .02).
In addition, the effect did not differ by prerandomization orthostatic hypotension status (P for interaction = .8).
“Our findings may seem at odds with clinical experience because many clinicians have observed hypotension, syncope and falls while treating their hypertensive patients,” Juraschek and colleagues wrote in the simultaneous publication. “This observation may be due to the acute effects of antihypertensive therapy before baroreflex sensitivity, vascular stiffness, ventricular diastolic filling and other blood pressure regulatory mechanisms have had a chance to adapt. The long-term treatment of hypertension has been shown to improve many of these mechanisms, which may explain the beneficial effect of treatment shown here.”
Reference:
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Juraschek SP, et al. Presentation MP36. Presented at: American Heart Association Hypertension Scientific Sessions; Sept. 10-13, 2020 (virtual meeting).
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