Faculty Collaboration Database

Orthostatic Hypotension, Cardiovascular Outcomes, and Adverse Events: Results From SPRINT. Hypertension 2020 Mar;75(3):660-667

Date

01/28/2020

Pubmed ID

31983312

Pubmed Central ID

PMC7261502

DOI

10.1161/HYPERTENSIONAHA.119.14309

Scopus ID

2-s2.0-85081143112 (requires institutional sign-in at Scopus site)   56 Citations

Abstract

Orthostatic hypotension (OH) is frequently observed with hypertension treatment, but its contribution to adverse outcomes is unknown. The SPRINT (Systolic Blood Pressure Intervention Trial) was a randomized trial of adults, age ≥50 years at high risk for cardiovascular disease with a seated systolic blood pressure (BP) of 130 to 180 mm Hg and a standing systolic BP ≥110 mm Hg. Participants were randomized to a systolic BP treatment goal of either <120 or <140 mm Hg. OH was defined as a drop in systolic BP ≥20 or diastolic BP ≥10 mm Hg 1 minute after standing from a seated position. We used Cox models to examine the association of OH with cardiovascular disease or adverse study events by randomized BP goal. During the follow-up period (median 3years), there were 1170 (5.7%) instances of OH among those assigned a standard BP goal and 1057 (5.0%) among those assigned the intensive BP goal. OH was not associated with higher risk of cardiovascular disease events (primary outcome: hazard ratio 1.06 [95% CI, 0.78-1.44]). Moreover, OH was not associated with syncope, electrolyte abnormalities, injurious falls, or acute renal failure. OH was associated with hypotension-related hospitalizations or emergency department visits (hazard ratio, 1.77 [95% CI, 1.11-2.82]) and bradycardia (hazard ratio, 1.94 [95% CI, 1.19-3.15]), but these associations did not differ by BP treatment goal. OH was not associated with a higher risk of cardiovascular disease events, and BP treatment goal had no effect on OH's association with hypotension and bradycardia. Symptomless OH during hypertension treatment should not be viewed as a reason to down-titrate therapy even in the setting of a lower BP goal. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT01206062.

Author List

Juraschek SP, Taylor AA, Wright JT Jr, Evans GW, Miller ER 3rd, Plante TB, Cushman WC, Gure TR, Haley WE, Moinuddin I, Nord J, Oparil S, Pedley C, Roumie CL, Whittle J, Wiggers A, Finucane C, Anne Kenny R, Appel LJ, Townsend RR, SPRINT Research Group

Author

Jeffrey Whittle MD Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Antihypertensive Agents
Asymptomatic Diseases
Blood Pressure
Bradycardia
Cardiovascular Diseases
Comorbidity
Female
Follow-Up Studies
Goals
Humans
Hypertension
Hypotension
Hypotension, Orthostatic
Male
Middle Aged
Proportional Hazards Models
Renal Insufficiency, Chronic
Risk