Orthostatic Hypotension, Cardiovascular Outcomes, and Adverse Events

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.

Diretrizes Brasileiras de Hipertensão Arterial – 2020

“…Em ECR, o controle da HA mostrou a diminuição de eventos CV sem aumento do no risco de HO ou quedas com lesão. [854][855][856] A HA mal controlada e determinados antihipertensivos, como os alfabloqueadores, podem provocar ou piorar a HO. A melhor opção para seu controle é o uso de medidas não medicamentosas como hidratação adequada, dieta normossódica, mudança lenta de decúbito, elevação da cabeceira e uso de meias elásticas.…”

Recent advances in managing primary hypertension

“…Orthostatic hypotension was not found to be related to higher risk for cardiovascular events. Although associated with hypotension-related hospitalizations and bradycardia, this risk was similar in the different arms of the study 21 . Finally, hemodynamic effects rather than tubular dysfunction are the proposed etiology for AKI cases 22 .…”

Orthostatic Hypertension and Hypotension and Outcomes in CKD: The CRIC (Chronic Renal Insufficiency Cohort) Study

“…16,22,23 Patients with orthostatic hypotension have been shown to be at increased risk for falls, ischemic stroke, coronary artery disease, heart failure, atrial fibrillation, CKD, cognitive function decline, and all-cause mortality, though a recent analysis from the systolic blood pressure intervention trial (SPRINT) study showed that orthostatic hypotension was not associated with a higher risk of cardiovascular disease events. [3][4][5][6][7][8][9][10]12,24,25 Less is known about orthostatic hypotension in patients with CKD. In the Irish Longitudinal Study on Ageing, 11% of participants with a GFR <60 ml/min/1.73m2 had orthostatic hypotension 14 .…”