For most patients High blood pressureA more aggressive decrease in blood pressure (BP) does not increase the risk of orthostatic hypotension (OH). Conversely, it seems to reduce risk, a new meta-analysis suggests.
In addition, pretreatment OH was not associated with more OH from aggressive treatment, said Dr. Stephen Jurashek, Principal Investigator at Harvard Medical School, Beth Israel Dikones Medical Center / Boston, Massachusetts. Said. theheart.org | Medscape Cardiology.
“Our study does not support recommendations for screening OH prior to BP treatment and in the context of BP treatment,” Juraschek said.
The study was presented at the Virtual American Heart Association (AHA) Hypertension 2020 Scientific Session, and at the same time Published online Nowadays Annual report of internal medicine..
“Main analysis”
Comments on the research theheart.org | Medscape Cardiology, Vivek Bhalla, MD, director of the Stanford Center for Hypertension, Stanford Medical School, California, said, “This is a key analysis of the key outcomes of drugs used to treat hypertension and has potential for newer, more intensive blood pressure practices. Guidelines for addressing barriers. “
“A meta-analysis can increase the statistical detection power to detect effects that may not be possible in individual trials with a small number of patients,” said Barra, who was not involved in the study.
“This study provides further statistical evidence that orthostatic hypotension is not a reason to avoid intensive treatment to lower blood pressure.”
Intensive BP treatment reduces the risk of cardiovascular disease, but there is ongoing concern that it may increase the risk of OH, an important risk factor for falls and fractures. syncope, dementia, stroke, And death. However, the individual trials were not definitive.
Dr. Stephen Jurasheck
Juraschek et al. Searched three large medical databases and conducted a randomized trial examining the effect of BP drugs on OH. I’m sitting in a standing position.
The primary analysis included individual patient data from 5 trials (AASK, ACCORD, SPRINT, SPS3, UKPDS) involving 18,466 participants (mean age, 64.5 years, 39% of women) and 127,998 times. A follow-up visit was included.
Intensive blood pressure goals varied from study to study. Two tests covered SBP <120 mm Hg (vs <140 mm Hg), one test covered SBP <130 mm Hg (vs 130-149 mm Hg), and one test was 92 mm Hg or less (vs <140 mm Hg). vs 102 to 107 mm Hg), and one study targeted SBP <150 mm Hg and DBP <85 mm Hg (vs <180 / <105 mm Hg).
All trials comparing different BP treatment goals showed reduced odds for OH treatment and the strongest relationship (odds ratio) for SPRINT. [OR], 0.89; 95% CI, 0.80-0.98).
In an integrated analysis of the five trials, assigning to a stronger (vs standard) BP goal also reduced OH odds (OR, 0.93, 95% CI, 0.86-0.99).
In adults without diabetes, the odds of OH with intensive BP treatment were even lower (OR, 0.90 vs 1.10; P interaction = .015) And adults with low standing SBP before treatment (or 0.66 below 110 mm Hg, 0.96 above 110 mm Hg; P interaction = .02However, it did not change significantly with age, gender, or black species.
The findings (overall and subgroup) have not changed in the sensitivity analysis, which includes four additional placebo-controlled trials.
No obstacles to severe blood pressure drop
“Our study incorporates a variety of treatments and goals and a large population over 75 years of age, strongly supporting that more intensive BP treatment usually does not induce OH even among the elderly. “The authors write.
In addition, this study suggests that intensive BP treatment may potentially improve postural regulation when standing, especially in adults with low standing blood pressure before treatment. Especially so.
“We know more intensive blood pressure control, especially in older people. Cardiovascular riskIs associated with better results, “Bara said. theheart.org | Medscape Cardiology.. “Of course, those patients are traditionally considered to be at higher risk of OH. That risk can increase the alertness of patients and clinicians to intensive care.”
“Perhaps the most important message is that orthostatic hypotension is not a major factor in the use of more intensive blood pressure control in the setting of clinical trials where patients are well supervised,” Bhalla emphasizes. did.
“Notably, in the real world, patients may be seen as often as patients in clinical trials and, if not supervised, many episodes of orthostatic hypotension due to intensive care. It is to have sex.
“But with proper supervision, careful follow-up, and efforts to reduce cardiovascular risk and improve patient outcomes through patient education, orthostatic hypotension is a barrier to more intensive blood pressure management. No need, “he added.
The study is backed by the NIH National Heart, Lung, and Blood Institute, and Juraschek and Bhalla do not reveal a related financial relationship.
Intern Med.. Published online on September 10, 2020. Overview
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