Symptom-Free Orthostatic Hypotension Not Tied to Extra Risks With Intensive BP Treatment

By David Douglas

February 08, 2020

NEW YORK (Reuters Health) - Non-symptomatic orthostatic hypotension found in the context of blood pressure treatment is not associated with higher risk of cardiovascular events, falls, or syncope, according to an analysis of the SPRINT randomized trial.

"Moreover," Dr. Stephen P. Juraschek told Reuters Health by email, "hypertension treatment did not alter the association between orthostatic hypotension and cardiovascular outcomes or adverse events."

More than 8,700 patients participated in SPRINT, which compared intensive treatment to a systolic blood pressure (SBP) target below 120 mm Hg with standard treatment to a SBP target below 140 mm Hg.

Orthostatic hypotension was defined as a drop in SBP of 20 mm hg or more or a drop in diastolic BP of 10 mm Hg or more one minute after standing from a seated position, Dr. Juraschek of Beth Israel Deaconess Medical Center, in Boston, and colleagues report in Hypertension.

During a median follow-up of three years there were 1,170 (5.7%) instances of orthostatic hypotension among those assigned a standard BP goal and 1,057 (5.0%) among those assigned the intensive BP goal.

Orthostatic hypotension was not associated with higher risk of cardiovascular disease events and was not associated with syncope, electrolyte abnormalities, injurious falls, or acute renal failure.

However, it was associated with significantly higher risks of hypotension-related hospitalizations or emergency department visits (hazard ratio, 1.77) and bradycardia (HR, 1.94). But these associations did not differ between those randomized to a standard or intensive BP treatment goal.

Thus, continued Dr. Juraschek "Our data challenges the notion that orthostatic hypotension in the setting of more-intensive blood pressure treatment represents a greater risk of adverse events from treatment."

Furthermore, he added "our data challenges the practice of reducing hypertension treatment in response to orthostatic hypotension."

"Orthostatic hypotension, Dr. Juraschek concluded, "should not be a reason for down-titration of antihypertensive medications, even in the setting of a lower blood pressure goal."

Dr. Teemu J. Niiranen of the University of Turku, in Finland, author of an accompanying editorial, told Reuters Health by email, "The study shows that asymptomatic orthostatic hypotension was not associated with increased risk of complications, even in the setting of intensive antihypertensive therapy."

"Therefore," Dr. Niiranen concluded, "if a patient who is treated for high blood pressure demonstrates a symptomless drop in blood pressure while standing up, this does not appear to be a reason to down-titrate medication."

SOURCE: and Hypertension, online January 27, 2020.