From the Division of Nephrology and Hypertension (M.R., N.P., R.K., J.T.W.).
Department of Neurology (Z.C., C.T.).
Hypertension. 2021 Jan;77(1):49-58. doi: 10.1161/HYPERTENSIONAHA.120.15887. Epub 2020 Nov 9.
We evaluated the association between orthostatic hypertension and cardiovascular outcomes and the effect of intensive blood pressure (BP) control on cardiovascular outcomes in patients with orthostatic hypertension. Post hoc analyses of the SPRINT (Systolic Blood Pressure Intervention Trial) data were conducted; orthostatic hypertension was defined as increase in systolic BP≥20 mm Hg or increase in diastolic BP≥10 mm Hg with standing. Of 9329 participants, 1986 (21.2%) had orthostatic hypertension at baseline. Within the intensive treatment group, participants with orthostatic hypertension were at higher risk of developing the composite cardiovascular outcome (hazard ratio, 1.44 [95% CI, 1.1-1.87], =0.007) compared with participants without orthostatic hypertension. Within the standard treatment group, there were no significant differences in cardiovascular outcome between participants with and without orthostatic hypertension. In participants with orthostatic hypertension, there was no statistically significant difference in risk of the composite cardiovascular outcome between the intensive and the standard BP treatment group (hazard ratio, 1.07 [95% CI, 0.78-1.47], =0.68). In participants without orthostatic hypertension at baseline, the intensive treatment group was associated with a lower risk of the composite cardiovascular outcome (hazard ratio, 0.67 [95% CI, 0.56-0.79], <0.0001). Orthostatic hypertension was associated with a higher risk of cardiovascular outcomes in the intensive and not in the standard treatment group; intensive treatment of BP did not reduce the risk of cardiovascular outcomes compared with standard treatment in patients with orthostatic hypertension. These post hoc analyses are hypothesis generating and will need to be confirmed in future studies.
我们评估了直立性高血压与心血管结局之间的关系，以及强化血压（BP）控制对直立性高血压患者心血管结局的影响。对 SPRINT（收缩压干预试验）数据进行了事后分析；直立性高血压的定义为站立时收缩压升高≥20mmHg 或舒张压升高≥10mmHg。在 9329 名参与者中，1986 名（21.2%）基线时患有直立性高血压。在强化治疗组中，与无直立性高血压的参与者相比，患有直立性高血压的参与者发生复合心血管结局的风险更高（危险比，1.44[95%CI，1.1-1.87]，=0.007）。在标准治疗组中，有直立性高血压和无直立性高血压的参与者之间心血管结局无显著差异。在有直立性高血压的参与者中，强化和标准 BP 治疗组之间复合心血管结局的风险无统计学显著差异（危险比，1.07[95%CI，0.78-1.47]，=0.68）。在基线时无直立性高血压的参与者中，强化治疗组复合心血管结局的风险较低（危险比，0.67[95%CI，0.56-0.79]，<0.0001）。直立性高血压与心血管结局风险增加相关，但仅与强化治疗组相关，与标准治疗组无关；与标准治疗相比，强化治疗血压并不能降低直立性高血压患者的心血管结局风险。这些事后分析是产生假说的，需要在未来的研究中得到证实。
