Orthostatic Hypotension, Cardiovascular Outcomes, and Adverse Events

Author:

Juraschek Stephen P.1,Taylor Addison A.2,Wright Jackson T.3,Evans Gregory W4,Miller Edgar R.5,Plante Timothy B.6,Cushman William C.7,Gure Tanya R.8,Haley William E.9,Moinuddin Imran10,Nord John11,Oparil Suzanne12,Pedley Carolyn13,Roumie Christianne L.14,Whittle Jeff15,Wiggers Alan16,Finucane Ciarán1718,Anne Kenny Rose19,Appel Lawrence J.5,Townsend Raymond R.20,

Affiliation:

1. From the Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.P.J.)

2. Michael E. DeBakey Veterans Affairs Medical Center and Department of Medicine, Baylor College of Medicine, Houston, TX (A.A.T.)

3. Department of Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH (J.T.W.)

4. Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC (G.W.E.)

5. The Johns Hopkins University School of Medicine, The Johns Hopkins Bloomberg School of Public Health, and The Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, MD (E.R.M., L.J.A.)

6. Larner College of Medicine at The University of Vermont, Burlington (T.B.P.)

7. Preventive Medicine Section, Memphis VA Medical Center, Memphis, TN (W.C.C.)

8. Division of General Internal Medicine and Geriatrics, Department of Internal Medicine, The Ohio State University, Columbus (T.R.G.)

9. Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL (W.E.H.)

10. Department of Medicine, University of Illinois at Chicago, College of Medicine, IL (I.M.)

11. Department of Internal Medicine; Salt Lake City VA Medical Center, UT (J.N.)

12. Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.O.)

13. Department of Internal Medicine, Wake Forest Baptist Medical Center, Winston-Salem, NC (C.P.)

14. Institute for Medicine and Public Health, Vanderbilt University Medical Center, VA Geriatric Research Education and Clinical Center, Nashville, TN (C.L.R.)

15. Clement J. Zablocki VA Medical Center, Milwaukee, WI (J.W.)

16. Department of Primary Care, Ohio University Heritage College of Osteopathic Medicine, Cleveland (A.W.)

17. Department of Medical Physics, Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland (C.F.)

18. Department of Medical Gerontology, Trinity College, Dublin, Ireland (C.F., R.A.K.)

19. Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland (R.A.K.)

20. Department of Medicine, Perelman School of Medicine, University of Pennsylvania (R.R.T.).

Abstract

Orthostatic hypotension (OH) is frequently observed with hypertension treatment, but its contribution to adverse outcomes is unknown. The SPRINT (Systolic Blood Pressure Intervention Trial) was a randomized trial of adults, age ≥50 years at high risk for cardiovascular disease with a seated systolic blood pressure (BP) of 130 to 180 mm Hg and a standing systolic BP ≥110 mm Hg. Participants were randomized to a systolic BP treatment goal of either <120 or <140 mm Hg. OH was defined as a drop in systolic BP ≥20 or diastolic BP ≥10 mm Hg 1 minute after standing from a seated position. We used Cox models to examine the association of OH with cardiovascular disease or adverse study events by randomized BP goal. During the follow-up period (median 3years), there were 1170 (5.7%) instances of OH among those assigned a standard BP goal and 1057 (5.0%) among those assigned the intensive BP goal. OH was not associated with higher risk of cardiovascular disease events (primary outcome: hazard ratio 1.06 [95% CI, 0.78–1.44]). Moreover, OH was not associated with syncope, electrolyte abnormalities, injurious falls, or acute renal failure. OH was associated with hypotension-related hospitalizations or emergency department visits (hazard ratio, 1.77 [95% CI, 1.11–2.82]) and bradycardia (hazard ratio, 1.94 [95% CI, 1.19–3.15]), but these associations did not differ by BP treatment goal. OH was not associated with a higher risk of cardiovascular disease events, and BP treatment goal had no effect on OH’s association with hypotension and bradycardia. Symptomless OH during hypertension treatment should not be viewed as a reason to down-titrate therapy even in the setting of a lower BP goal. Clinical Trial Registration URL: https://www.clinicaltrials.gov . Unique identifier: NCT01206062.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Internal Medicine

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