Harvard Medical School, Boston, MA (B.G.).
Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (B.G., R.-A.N.T.-O., L.A.L., K.J.M., S.P.J.).
Hypertension. 2023 Apr;80(4):820-827. doi: 10.1161/HYPERTENSIONAHA.122.20602. Epub 2023 Feb 6.
We recently demonstrated that more intensive blood pressure (BP) treatment lowered risk of orthostatic hypotension (OH) measured with a seated-to-standing protocol. However, seated-to-standing OH assessments are less sensitive than supine-to-standing and could miss clinically relevant OH.
Using data from the Syst-Eur trial (Systolic Hypertension in Europe), we examined the effect of hypertension treatment on incidence of OH based on the difference in BP from 3 body positions.
Syst-Eur was a multi-center, randomized trial that enrolled adults with isolated systolic hypertension to investigate whether active hypertension treatment could reduce cardiovascular events. Participants underwent BP measurement in supine, seated, and standing positions. Using differences in BP between the 3 body positions (seated minus supine, standing minus seated, and standing minus supine), we defined OH as a drop in systolic BP ≥20 mm Hg or diastolic BP ≥10 mm Hg. We included measurements from baseline and follow-up visits.
Among 4695 participants (mean age, 70.2±6.7 years; 66.9% female) with 42 636 BP measurements, OH was present in 4.9% of measures with supine-to-seated, 7.9% with seated-to-standing, and 11.4% with supine-to-standing protocols, respectively. Compared with placebo, BP treatment did not increase OH with any set of maneuvers, OR, 0.79 (95% CI, 0.65-0.95) with seated-to standing, 1.03 (95% CI, 0.86-1.24) with supine-to-seated, and 0.99 (95% CI, 0.86-1.15) with supine-to-standing.
Regardless of protocol, active hypertension treatment did not increase the risk of OH, reinforcing evidence that OH should not be viewed as a complication of hypertension treatment.
URL: https://www.
gov; Unique identifier: NCT02088450.
我们最近的研究表明，更严格的血压（BP）治疗通过坐姿到站立的方案降低体位性低血压（OH）的风险。然而，坐姿到站立的 OH 评估不如仰卧位到站立位敏感，可能会错过临床相关的 OH。
使用来自 Syst-Eur 试验（欧洲收缩期高血压）的数据，我们根据 3 个体位之间的 BP 差异，研究高血压治疗对 OH 发生率的影响。
Syst-Eur 是一项多中心、随机试验，纳入了单纯收缩期高血压的成年人，以研究积极的高血压治疗是否可以降低心血管事件。参与者接受仰卧位、坐位和站立位的 BP 测量。我们使用 3 个体位之间的 BP 差异（坐位减仰卧位、站立位减坐位和站立位减仰卧位）来定义 OH，即收缩压下降≥20mmHg 或舒张压下降≥10mmHg。我们纳入了基线和随访时的测量结果。
在 4695 名参与者（平均年龄 70.2±6.7 岁，66.9%为女性）中，共进行了 42636 次 BP 测量，仰卧位到坐位、坐位到站立位和仰卧位到站立位的 OH 分别出现在 4.9%、7.9%和 11.4%的测量中。与安慰剂相比，BP 治疗并没有增加任何一组操作的 OH 风险，坐位到站立位的 OR 为 0.79（95%CI，0.65-0.95），仰卧位到坐位的 OR 为 1.03（95%CI，0.86-1.24），仰卧位到站立位的 OR 为 0.99（95%CI，0.86-1.15）。
无论使用哪种方案，积极的高血压治疗都不会增加 OH 的风险，这进一步证明了 OH 不应被视为高血压治疗的并发症。
NCT02088450。
