Don’t faint: intensive BP lowering is linked to reduced risk for orthostatic hypotension

  • Juraschek SP & al.
  • Ann Intern Med
  • 10 sept. 2020

  • de Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • Intensive BP lowering is not linked to orthostatic hypotension, according to the results of this meta-analysis of 9 randomized trials.

Why this matters

  • These authors say that onset of orthostatic hypotension should not be viewed as a reason to dial back or cease BP-lowering therapy.

Key results

  • The analysis included 5 open-label randomized treatment-goal trials (including SPRINT) with a total of 18,466 participants (range, 1090-9361).
  • They also analyzed data from 4 separate placebo-controlled trials.
  • BP goals varied in targets, e.g., a range of systolic BP targets from
  • Intertrial heterogeneity was low.
  • Orthostatic hypotension was decreased across treatment-goal trials.
    • SPRINT had the strongest association of BP reduction with reduced orthostatic hypotension odds: OR, 0.89 (95% CI, 0.80-0.98).
  • The placebo-controlled trials showed no effect.
  • Pooling all 9 trials yielded lower orthostatic hypotension risk with intensive BP treatment: OR, 0.93 (95% CI, 0.89-0.98).
  • No effects by sex, etc., seen.

Study design

  • Meta-analysis, systematic review.
  • Funding: National Heart, Lung, and Blood Institute; NIH.

Limitations

  • No data on falls, syncope.