Intensive BP Treatment Lowers Risk for Orthostatic Hypotension

A systematic review suggested that Intensive blood pressure (BP)-lowering treatment decreases risk for orthostatic hypotension (OH). OH, 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. The data were extracted from 5 trials examined BP treatment goals, and 4 examined active agents versus placebo. Trials examining BP treatment goals included 18 466 participants (mean age 64.5 years, 38.9% women) with 127 882 follow-up visits. Trials were open-label, with minimal heterogeneity of effects across trials. Intensive BP treatment lowered risk for OH (odds ratio, 0.93). Effects did not differ by prerandomization OH. In sensitivity analyses that included 4 additional placebo-controlled trials, overall and subgroup findings were unchanged. The findings support the growing body of evidence that OH identified in the setting of intensive BP treatment should not be viewed as a reason to down titrate or discontinue BP treatment. OH in BP-lowering therapy may be due to the acute effects of antihypertensive therapy before the longer-term adaptations have a chance to occur. Certain hypertension medications, such as alpha-1 blockers, are known for causing OH. Source: https://www.acpjournals.org/