Hypertension Treatment Lowers Risk of Hypotension Upon Standing

Hypertension treatment did not raise, indeed lowers the risk of developing an extreme drop in blood pressure upon standing, according to new research to be presented at the virtual American Heart Association's Hypertension 2020 Scientific Sessions.

Orthostatic hypotension occurs when standing from sitting or lying down. Symptoms include feelings of dizziness or light-headedness and sometimes even fainting. The condition is more common among older adults, however, other factors also can increase the risk, including other conditions, such as heart disease and diabetes, and some medications.

‘New study findings could be reassuring to clinicians on the safety of blood pressure treatment with regard to orthostatic hypotension.’

In this study, researchers analyzed the results of nine separate studies as a meta-analysis, which can provide more information when analyzed collectively.

"Our findings should challenge the traditional teaching about blood pressure treatment causing orthostatic hypotension, reassuring clinicians about the safety of blood pressure treatment with regard to this condition," said principal investigator Stephen P. Juraschek, M.D., Ph.D., a clinician investigator at Beth Israel Deaconess Medical Center-Harvard Medical School in Boston.

Investigators reviewed databases- MEDLINE, EMBASE and CENTRAL --from October 7, 2019, to find studies that examined the effects of blood pressure medications on orthostatic hypotension.

For this analysis, researchers reviewed the health records of 31,043 adults with diagnosed hypertension. Nearly half of participants were women, one-fourth were over age 75 and one in five were African American.

"The study population was diverse, including older adults with a number of chronic conditions associated with cardiovascular disease, like diabetes," Juraschek said. "Nevertheless, the findings were consistent across subgroups."

Almost 50% of the patients were treated more aggressively, either to a lower blood pressure goal or with an active drug versus placebo. The greatest decrease in risk occurred among those with the lowest blood pressure upon standing, compared to participants with higher blood pressure on standing.

"Orthostatic hypotension identified in the setting of intensive blood pressure treatment should not be viewed as a reason to decrease or discontinue blood pressure treatment," Juraschek said. "In fact, the finding that more aggressive blood pressure treatment lowered orthostatic hypotension was relatively consistent across the studies."

Inconsistent information could be one of the limitation of the study. Another limitation is that some cases of low blood pressure could have been missed, since most measurements occurred after one minute, instead of within the first minute of standing.

The study did not include information about the classes of blood pressure medication used by participants.



Source: Eurekalert