Intensive management of high blood pressure appears to lower the risk of orthostatic hypotension, or a drop in blood pressure upon standing, researchers are reporting in a systematic review of published evidence. Orthostatic hypotension should therefore not be a reason to avoid or reduce treatment for hypertension, the researchers suggest.
Doctors have had growing concerns that intensive blood pressure-lowering treatment, while beneficial for fighting cardiovascular disease, might trigger orthostatic hypotension, which is an important risk factor for falls particularly in the elderly. The condition is common in adults with hypertension and is associated with multiple classes of antihypertensive drugs. Whether or not it is a complication of intensive blood pressure therapy is unclear.
To find out, an international team of researchers systematically reviewed existing hypertension trials using data for more than 18,000 adults with hypertension, in which sitting and standing blood pressures were measured, to assess for orthostatic hypotension. The data showed that lower blood pressure targets reduced the risk of orthostatic hypotension regardless of age, standing hypotension status, or orthostatic hypotension prior to treatment. They found that intensive blood pressure treatment may even improve blood pressure regulation in adults with standing hypotension.
The findings suggest that screening for orthostatic hypotension in hypertensive individuals, which guidelines currently recommend, may not be needed, the researchers say. Their study, funded by NHLBI, appeared in Annals of Internal Medicine and was presented simultaneously at the American Heart Association Hypertension 2020 Scientific Sessions.