Orthostatic Hypotension

Despite Belief, BP-Lowering Therapy Does Not Increase Risk for Orthostatic Hypotension

Intensive blood-pressure–lowering treatment does not affect the development of orthostatic hypotension among adults with hypertension, according to new research presented at the American Heart Association’s Hypertension Sessions 2020.1

“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,” said principal investigator Stephen P. Juraschek, MD, PhD, in a press release.2

To conduct their study, the researchers performed a literature search of MEDLINE, EMBASE, and Cochrane CENTRAL from inception through October 7, 2019.

Their analysis included 5 randomized trials that examined blood pressure goals and 4 that examined active agents vs placebo. To be included in the analysis, the trials must have had included more than 500 adults with hypertension or elevated blood pressure and that were at least 6 months in duration.

Orthostatic hypotension was defined as a decrease of 20 mm Hg or more in systolic blood pressure or a decrease of 10 mm Hg or more in diastolic blood pressure after changing position from seated to standing.

Results of the analysis, which included 18,466 participants overall, showed that intensive blood pressure treatment had lowered the risk of orthostatic hypotension (odds ratio, 0.93 [95% CI, 0.86 to 0.99]).

These effects did not differ by pre-randomization orthostatic hypotension, and overall and subgroup findings did not change after sensitivity analyses.

“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,” the researchers concluded.

—Amanda Balbi

References:

  1. Juraschek SP, Hu JR, Cluett JL, et al. Effects of intensive blood pressure treatment on orthostatic hypotension: a systemic review and individual participant-based meta-analysis. Paper presented at: American Heart Association’s Hypertension Sessions 2020; September 10-13, 2020; Virtual. https://www.acpjournals.org/doi/10.7326/M20-4298
  2. High blood pressure treatment linked to less risk for drop in blood pressure upon standing. News release. American Heart Association. September 10, 2020. Accessed September 10, 2020. https://newsroom.heart.org/news/high-blood-pressure-treatment-linked-to-less-risk-for-drop-in-blood-pressure-upon-standing