Orthostatic hypotension (OH), a drop in blood pressure (BP) after standing, is common among older adults and has been reported to be an important predictor of falls and fainting, as well as cardiovascular disease (CVD). OH is highly prevalent among older adults with abnormally high blood pressure, or hypertension, and among those taking medication to treat hypertension. In light of recently updated guidelines recommending a lower threshold for the treatment of hypertension, some physicians have expressed concerns that aggressive efforts to lower BP, especially in older adults, might increase OH and its associated adverse events.
However, contrary to this notion, researchers at Beth Israel Deaconess Medical Center (BIDMC) have found that OH was not associated with higher risk of cardiovascular events, falls, or fainting among participants in The Systolic Blood Pressure Intervention Trial. In a study published in the journal Hypertension, the scientists showed that hypertension treatment had no impact on the link between OH and cardiovascular outcomes or other adverse events. These findings provide strong evidence that OH should not be a reason to lower medication doses, even in the setting of a lower BP goal.
There are ongoing concerns that orthostatic hypotension among patients undergoing more intensive blood pressure treatment represents a greater risk of adverse events from treatment. Our research findings challenge this notion and the practice of reducing hypertension treatment in response to orthostatic hypotension. These findings are important since many people worry about adverse effects from blood pressure treatment in older adults."
Stephen Juraschek, MD, PhD, corresponding author, Assistant Professor of Medicine at BIDMC