By Amy Orciari Herman
NEJM Journal Watch
Edited by William E. Chavey, MD, MS
In patients with hypertension, intensive blood pressure lowering is associated with reduced risk for orthostatic hypotension, according to a meta-analysis published in the Annals of Internal Medicine and presented at the American Heart Association’s Hypertension Scientific Sessions. The finding may seem counterintuitive to those who’ve witnessed hypotension and syncope in patients receiving antihypertensive treatment.
Researchers examined five trials that compared intensive with standard BP lowering among some 18,000 adults. Intensive BP goals varied across the studies — for example, two trials targeted a systolic BP below 120 mm Hg, while another targeted a mean arterial pressure of 92 mm Hg or less.
When the trials were pooled together, intensive BP lowering was associated with a significant 7% reduction in the odds of orthostatic hypotension.
The researchers note that long-term hypertension treatment improves many BP regulatory mechanisms, which could explain the benefit of intensive treatment observed here.