The risk associations of antihypertensive medications with orthostatic hypotension have long been debated. Therefore, many physicians consider orthostatic hypotension as a reason to relax, avoid or de-escalate treatment of high blood pressure.
Researchers at the Beth Israel Deaconess Medical Center (BIDMC), found that treatment for lower high blood pressure did not increase the risk of developing orthostatic hypotension. On the other hand, it decreases the risk of orthostatic hypotension. Therefore, it is not advisable to stop or reduce the use of antihypertensive medication, to reduce the risk of lowering blood pressure on standing up.
Lead investigator Stephen Juraschek, says, “Our findings should challenge the traditional teaching about blood pressure treatment causing orthostatic hypotension, reassuring clinicians about the safety of blood pressure treatment with regard to this condition.”
Researchers reviewed the health records from nine large clinical trials consisting of 31,043 adults diagnosed with hypertension. Nearly half of the participants were women, one-fourth were over age 75 years, and one in five was African American.
“The study population was diverse, including older adults with a number of chronic conditions associated with cardiovascular disease, including diabetes,” said Juraschek.
Around 50% of the patients were treated to either a lower blood pressure goal versus a higher blood pressure goal or with an active drug versus placebo.
The results showed that the risk for low blood pressure upon standing was lower in participants who took medication to lower blood pressure.
The greatest decrease in the risk was seen in those with the lowest blood pressure upon standing, compared to those with higher blood pressure on standing.
The second-greatest decrease in risk was seen in participants without diabetes compared to those with diabetes.
The authors concluded that orthostatic hypotension should not be used as a reason to decrease or discontinue blood pressure treatment, because the finding states that more aggressive blood pressure treatment lowered orthostatic hypotension considerably.
The new study is published in Annals of Internal Medicine.
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