期刊
HYPERTENSION
卷 75, 期 3, 页码 660-667出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1161/HYPERTENSIONAHA.119.14309
关键词
blood pressure; cardiovascular disease; hypertension; orthostatic hypotension; syncope
资金
- National Institutes of Health (NIH)/National Heart, Lung, and Blood Institute (NHLBI) [K23HL135273]
- NIH
- NHLBI
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
- National Institute on Aging (NIA)
- National Institute of Neurological Disorders and Stroke (NINDS) [HHSN268200900040C, HHSN268200900046C, HHSN268200900047C, HHSN268200900048C, HHSN268200900 049C, A-HL-13-002-001]
- Department of Veterans Affairs
- National Center for Advancing Translational Sciences: Case Western Reserve University [UL1TR000439]
- National Center for Advancing Translational Sciences: Ohio State University [UL1RR025755]
- National Center for Advancing Translational Sciences: U Penn [UL1RR024134, UL1TR000003]
- National Center for Advancing Translational Sciences: Boston [UL1RR025771]
- National Center for Advancing Translational Sciences: Stanford [UL1TR000093]
- National Center for Advancing Translational Sciences: Tufts [UL1RR025752, UL1TR000073, UL1TR001064]
- National Center for Advancing Translational Sciences: University of Illinois [UL1TR000050]
- National Center for Advancing Translational Sciences: University of Pittsburgh [UL1TR000005]
- National Center for Advancing Translational Sciences: UT Southwestern [9U54TR000017-06]
- National Center for Advancing Translational Sciences: University of Utah [UL1TR000105-05]
- National Center for Advancing Translational Sciences: Vanderbilt University [UL1 TR000445]
- National Center for Advancing Translational Sciences: George Washington University [UL1TR000075]
- National Center for Advancing Translational Sciences: University of CA, Davis [UL1 TR000002]
- National Center for Advancing Translational Sciences: University of Florida [UL1 TR000064]
- National Center for Advancing Translational Sciences: University of Michigan [UL1TR000433]
- National Center for Advancing Translational Sciences: Tulane University: COBRE Award NIGMS [P30GM103337]
- National Center for Advancing Translational Sciences: Wake Forest University [UL1TR001420]
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.
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