No Added Orthostatic Hypotension from More Intense Blood Pressure Treatment

Stephen Juraschek, MD, PhD

A recent study from investigators at Beth Israel Deaconess Medical Center had found that patients receiving more intense antihypertensive treatment had fewer episodes of orthostatic hypotension.

The study, which was presented at the American Heart Association's Hypertension 2019 Scientific Sessions, examined the effect of antihypertensive treatment on orthostatic hypotension in more than 2500 adult patients who had a recent stroke.

"Falls can be devastating in this older population," said lead investigator Stephen Juraschek, MD, PhD, an assistant professor of medicine at Harvard Medical School and an internal medicine physician at Beth Israel Deaconess Medical Center in Boston, Mass. "As a result, there is substantial concern about anything that might increase their fall risk. However, our study provides strong evidence that intense blood pressure treatment does not induce orthostatic hypotension or its symptoms."

To assess the effect of systolic blood pressure goal on orthostatic hypertension, investigators examined the Secondary Prevention of Small Subcortical Strokes - Blood Pressure (SPS3-BP), which was an open label, randomized trial. All adults included in the study had suffered a suffered a stroke within the prior 6 months and were assigned to systolic blood pressure goal of either 130 to 149 mmHg or less than 130 mmHg.

During the study’s follow-up period, all participants underwent blood pressure measurement 3 times in a seated position and once more after 2 minutes of standing. Patients were asked about dizziness and lightheadedness in the process of standing up.

Investigators defined orthostatic hypotension as a drop in systolic blood pressure of 20 mmHg or greater or diastolic blood pressure 10 mmHg or greater. Additionally, investigators examined extreme standing blood pressure values, which were defined as systolic blood pressure 190 mmHg or greater or 90 mmHg or fewer and diastolic blood pressure 110 mmHg or greater or 40 mmHg or less.

A total of 2876 participants had 36,342 visits. The mean age of participants was 62.8 years, 37% were women, and 16% were black with a mean of 15 follow-up visits. Orthostatic hypotension was presented 2591 times in 1165 participants. Investigators noted dizziness was presented 1343 times and lightheadedness was present 941 times.

A lower systolic blood pressure goal was associated with a lower risk of orthostatic hypotension (OR 0.86; 95% CI: 0.75, 0.99), a higher risk of systolic blood pressure 90 mmHg or greater (3.79; 2.35, 6.11), or diastolic blood pressure 40 mmHg or fewer, (2.42; 1.41, 4.15), and a lower risk of systolic blood pressure 190 mmHg or greater (0.40; 0.27, 0.60), or diastolic blood pressure of 110 mmHg or greater (0.31; 0.19, 0.50).

This study, “The Effects of a Lower Blood Pressure Treatment Goal on Orthostatic Hypotension in Adults With Recent Stroke,” was presented at the American Heart Association’s Hypertension 2019 Scientific Sessions.