Intensive Hypertension Treatment Lowers Orthostatic Hypotens
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For most patients with hypertension, more aggressive blood pressure (BP) lowering does not increase risk for orthostatic hypotension (OH); on the contrary, it appears to lower the risk, a new meta-analysis suggests.

This study aimed to examine the effects of intensive BP-lowering treatment on OH in hypertensive adults.

Randomized trials of BP pharmacologic treatment (more intensive BP goal or active agent) that involved more than 500 adults with hypertension or elevated BP and that were 6 months or longer in duration were studied. Trial comparisons were groups assigned to either less intensive BP goals or placebo, and the outcome was measured OH, defined as a decrease of 20 mm Hg or more in systolic BP or 10 mm Hg or more in diastolic BP after changing position from seated to standing.

Five trials examined BP treatment goals, and 4 examined active agents versus placebo. Trials examining BP treatment goals included 18466 participants with 127882 follow-up visits. Trials were open-label, with minimal heterogeneity of effects across trials. Intensive BP treatment lowered risk for OH. Effects did not differ by prerandomization OH. In sensitivity analyses that included 4 additional placebo-controlled trials, overall and subgroup findings were unchanged.

Conclusively, Intensive BP-lowering treatment decreases risk for OH. Orthostatic hypotension, before or in the setting of more intensive BP treatment, should not be viewed as a reason to avoid or de-escalate treatment for hypertension.

Source: https://www.acpjournals.org/doi/10.7326/M20-4298
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