Orthostatic hypotension in hypertensive patients: About 200 cases

Hendy, Iliass; Zbitou, Asma; Chatoui, A.; Amal, Aziz Rbaibi , Ali Khatouri and Said; Bendriss, Laila; Khatouri, A.

doi:10.1016/j.acvdsp.2017.11.225

Cited by 1 publication

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“…Orthostatic hypotension has also been reported to be an independent risk factor for cardiovascular disease and mortality [ 5 ]. It is estimated that approximately 10% of hypertensive individuals attending specialist clinics have co-existing orthostatic hypotension [ 70 , 71 ]. Clinicians may be more cautious initiating antihypertensive therapy in those with co-existing orthostatic hypotension; however, the risk of orthostatic hypotension is higher in those with uncontrolled hypertension [ 72 , 73 ].…”

Section: Discussionmentioning

confidence: 99%

Randomised controlled trials of antihypertensive therapy: does exclusion of orthostatic hypotension alter treatment effect? A systematic review and meta-analysis

et al. 2023

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Background and purpose Management of antihypertensive therapy is challenging in patients with symptomatic orthostatic hypotension, a population often excluded from randomised controlled trials of antihypertensive therapy. In this systematic review and meta-analysis, we sought to determine whether the association of antihypertensive therapy and adverse events (e.g. falls, syncope), differed among trials that included or excluded patients with orthostatic hypotension. Methods We performed a systematic review and meta-analysis of randomised controlled trials comparing blood pressure lowering medications to placebo, or different blood pressure targets on falls or syncope outcomes and cardiovascular events. A random-effects meta-analysis was used to estimate a pooled treatment-effect overall in subgroups of trials that excluded patients with orthostatic hypotension and trials that did not exclude patients with orthostatic hypotension, and tested P for interaction. The primary outcome was fall events. Results 46 trials were included, of which 18 trials excluded orthostatic hypotension and 28 trials did not. The incidence of hypotension was significantly lower in trials that excluded participants with orthostatic hypotension (1.3% versus 6.2%, P < 0.001) but not incidences of falls (4.8% versus 8.8%; P = 0.40) or syncope (1.5% versus 1.8%; P = 0.67). Antihypertensive therapy was not associated with an increased risk of falls in trials that excluded (OR 1.00, 95% CI; 0.89–1.13) or included (OR 1.02, 95% CI; 0.88–1.18) participants with orthostatic hypotension (P for interaction = 0.90). Conclusions The exclusion of patients with orthostatic hypotension does not appear to affect the relative risk estimates for falls and syncope in antihypertensive trials.

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