From the Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.P.J.).
Michael E. DeBakey Veterans Affairs Medical Center and Department of Medicine, Baylor College of Medicine, Houston, TX (A.A.T.).
Hypertension. 2020 Mar;75(3):660-667. doi: 10.1161/HYPERTENSIONAHA.119.14309. Epub 2020 Jan 27.
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.
体位性低血压（OH）在高血压治疗中经常观察到，但它对不良结局的贡献尚不清楚。SPRINT（收缩压干预试验）是一项针对年龄≥50 岁、心血管疾病高危人群的随机试验，坐位收缩压（BP）为 130 至 180mmHg，站立时收缩压≥110mmHg。参与者被随机分配到收缩压治疗目标为<120 或<140mmHg。OH 定义为从坐位站立 1 分钟后收缩压下降≥20mmHg 或舒张压下降≥10mmHg。我们使用 Cox 模型检查 OH 与按随机 BP 目标分组的心血管疾病或不良研究事件的相关性。在随访期间（中位数 3 年），标准 BP 目标组中有 1170 例（5.7%）发生 OH，强化 BP 目标组中有 1057 例（5.0%）发生 OH。OH 与心血管疾病事件风险增加无关（主要结局：风险比 1.06 [95%CI，0.78-1.44]）。此外，OH 与晕厥、电解质异常、受伤性跌倒或急性肾衰竭无关。OH 与低血压相关的住院或急诊就诊（风险比，1.77 [95%CI，1.11-2.82]）和心动过缓（风险比，1.94 [95%CI，1.19-3.15]）相关，但这些相关性与 BP 治疗目标无关。OH 与心血管疾病事件风险增加无关，BP 治疗目标对 OH 与低血压和心动过缓的相关性没有影响。高血压治疗期间无症状性 OH 不应被视为降低治疗剂量的理由，即使在较低的 BP 目标下也是如此。临床试验注册网址：https://www.clinicaltrials.gov。独特标识符：NCT01206062。
