TY - JOUR
T1 - Orthostatic Hypotension, Cardiovascular Outcomes, and Adverse Events
T2 - Results From SPRINT
AU - SPRINT Research Group
AU - Juraschek, Stephen P.
AU - Taylor, Addison A.
AU - Wright, Jackson T.
AU - Evans, Gregory W.
AU - Miller, Edgar R.
AU - Plante, Timothy B.
AU - Cushman, William C.
AU - Gure, Tanya R.
AU - Haley, William E.
AU - Moinuddin, Imran
AU - Nord, John
AU - Oparil, Suzanne
AU - Pedley, Carolyn
AU - Roumie, Christianne L.
AU - Whittle, Jeff
AU - Wiggers, Alan
AU - Finucane, Ciarán
AU - Anne Kenny, Rose
AU - Appel, Lawrence J.
AU - Townsend, Raymond R.
PY - 2020/3/1
Y1 - 2020/3/1
N2 - 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.
AB - 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.
KW - blood pressure
KW - cardiovascular disease
KW - hypertension
KW - orthostatic hypotension
KW - syncope
UR - http://www.scopus.com/inward/record.url?scp=85081143112&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85081143112&partnerID=8YFLogxK
U2 - 10.1161/HYPERTENSIONAHA.119.14309
DO - 10.1161/HYPERTENSIONAHA.119.14309
M3 - Article
C2 - 31983312
SN - 0194-911X
VL - 75
SP - 660
EP - 667
JO - Hypertension (Dallas, Tex. : 1979)
JF - Hypertension (Dallas, Tex. : 1979)
IS - 3
ER -