Orthostatic Hypotension, Cardiovascular Outcomes, and Adverse Events: Results From SPRINT. Issue 3 (March 2020)

• Record Type: Journal Article
• Authors: Juraschek, Stephen P.; Taylor, Addison A.; Wright, Jackson T.; Evans, Gregory W; Miller, Edgar R.; Plante, Timothy B.; Cushman, William C.; Gure, Tanya R.; Haley, William E.; Moinuddin, Imran; Nord, John; Oparil, Suzanne; Pedley, Carolyn; Roumie, Christianne L.; Whittle, Jeff; Wiggers, Alan; Finucane, Ciarán; Anne Kenny, Rose; Appel, Lawrence J.; Townsend, Raymond R.
• Is Part Of: Hypertension. Volume 75:Issue 3(2020)
• Publication Date: 2020-03
• Subjects: blood pressure -- cardiovascular disease -- hypertension -- orthostatic hypotension -- syncope; Hypertension -- Periodicals; Hypertension -- Treatment -- Periodicals; 616.132005
• DOI: 10.1161/HYPERTENSIONAHA.119.14309
• Languages: English
• ISSNs: 0194-911X

Abstract

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. Abstract : Supplemental Digital Content is available in the text.