Orthostatic Hypotension, Cardiovascular Outcomes, and Adverse Events
Year: 2020
Type: article
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.
Source: Hypertension
Authors: Stephen P. Juraschek, Addison A. Taylor, Jackson T. Wright, Gregory W Evans, Edgar R. Miller, Timothy B. Plante, William C. Cushman, Tanya R. Gure, William E. Haley, Imran Moinuddin, John Nord, Suzanne Oparil, Carolyn Pedley, Christianne L. Roumie, Jeff Whittle, Alan Wiggers, Ciarán Finucane, Rose Anne Kenny, Lawrence J. Appel, Raymond R. Townsend
Institutions: Beth Israel Deaconess Medical Center, Harvard University, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, University Hospitals of Cleveland, University Hospitals Cleveland Medical Center, Case Western Reserve University, Wake Forest University Health Sciences, Wake Forest University, Johns Hopkins University, University of Vermont, Memphis VA Medical Center, The Ohio State University, Mayo Clinic in Florida, University of Illinois Chicago, VA Salt Lake City Healthcare System, Lake City VA Medical Center, University of Alabama at Birmingham, UAB Medicine, Atrium Health Wake Forest Baptist, Vanderbilt University, Vanderbilt University Medical Center, Milwaukee VA Medical Center, Ohio University, Trinity College Dublin, St. James's Hospital, University of Pennsylvania
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: National Institutes of Health, National Institute on Aging, National Heart, Lung, and Blood Institute, National Institute of General Medical Sciences, National Institute of Diabetes and Digestive and Kidney Diseases, National Center for Research Resources, National Center for Advancing Translational Sciences
Awards: Stanford Center for Clinical and Translational Education and Research (SCCTER)UL1, G1201304535, G130883262, G1346455397, G1369302522, G1442900148, G1452718737, G1534123016, G1575401839, G1815451664, G2244966566, The Ohio State University Center for Clinical and Translational Science (UL1), Tufts Clinical and Translational Research Institute, Stanford Center for Clinical & Translational Education and Research (Spectrum), G3042542605, G3211493418, Translational Research in Hypertension and Renal Biology, UC Davis Clinical and Translational Science Center, G3759862710, Clinical and Translational Science Institute at Children's National, UF Clinical and Translational Science Award, G5068655555, G522538789, Institutional Clinical and Translational Science Award, G576625284, G5831220822, Tufts Clinical and Translation Science Institute (UL1), G5971433106, G742032275, Institutional Clinical and Translational Science Award, The Vanderbilt Institute for Clinical and Translational Research (VICTR), Clinical and Translational Science Collaborative of Cleveland, G8723760441, Clinical and Translational Science Collaborative of Cleveland, G884570035, G94668252
OpenAlex ID: W3001383531