Orthostatic Hypotension, Hypertension Treatment, and Cardiovascular Disease: An Individual Participant Meta-Analysis.

Autor:	Juraschek SP; Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts., Hu JR; Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut., Cluett JL; Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts., Ishak AM; Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.; Healthcare Associates, Beth Israel-Lahey Health System, Boston, Massachusetts., Mita C; Countway Library, Harvard University, Boston, Massachusetts., Lipsitz LA; Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.; Hebrew SeniorLife, Hinda and Arthur Marcus Institute for Aging Research and Harvard Medical School, Boston, Massachusetts., Appel LJ; Johns Hopkins University, Baltimore, Maryland., Beckett NS; Guy's and St Thomas' NHS Foundation Trust, London, England., Coleman RL; Diabetes Trials Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, England., Cushman WC; Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis., Davis BR; Department of Biostatistics and Data Science, Coordinating Center for Clinical Trials, The University of Texas School of Public Health, Houston., Grandits G; Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis., Holman RR; Diabetes Trials Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, England., Miller ER 3rd; Johns Hopkins University, Baltimore, Maryland., Peters R; The George Institute for Global Health, Sydney, Australia.; Department of Biomedical Sciences, University of New South Wales, Sydney, Australia.; School of Public Health, Imperial College London, London, England., Staessen JA; Research Association Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium.; Biomedical Research Group, Faculty of Medicine, University of Leuven, Leuven, Belgium., Taylor AA; Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas., Thijs L; Sint-Franciscuscollege, Heusden-Zolder, Belgium., Wright JT Jr; Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio., Mukamal KJ; Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Jazyk:	angličtina
Zdroj:	JAMA [JAMA] 2023 Oct 17; Vol. 330 (15), pp. 1459-1471.
DOI:	10.1001/jama.2023.18497
Abstrakt:	Importance: There are ongoing concerns about the benefits of intensive vs standard blood pressure (BP) treatment among adults with orthostatic hypotension or standing hypotension. Objective: To determine the effect of a lower BP treatment goal or active therapy vs a standard BP treatment goal or placebo on cardiovascular disease (CVD) or all-cause mortality in strata of baseline orthostatic hypotension or baseline standing hypotension. Data Sources: Individual participant data meta-analysis based on a systematic review of MEDLINE, EMBASE, and CENTRAL databases through May 13, 2022. Study Selection: Randomized trials of BP pharmacologic treatment (more intensive BP goal or active agent) with orthostatic hypotension assessments. Data Extraction and Synthesis: Individual participant data meta-analysis extracted following PRISMA guidelines. Effects were determined using Cox proportional hazard models using a single-stage approach. Main Outcomes and Measures: Main outcomes were CVD or all-cause mortality. Orthostatic hypotension was defined as a decrease in systolic BP of at least 20 mm Hg and/or diastolic BP of at least 10 mm Hg after changing position from sitting to standing. Standing hypotension was defined as a standing systolic BP of 110 mm Hg or less or standing diastolic BP of 60 mm Hg or less. Results: The 9 trials included 29 235 participants followed up for a median of 4 years (mean age, 69.0 [SD, 10.9] years; 48% women). There were 9% with orthostatic hypotension and 5% with standing hypotension at baseline. More intensive BP treatment or active therapy lowered risk of CVD or all-cause mortality among those without baseline orthostatic hypotension (hazard ratio [HR], 0.81; 95% CI, 0.76-0.86) similarly to those with baseline orthostatic hypotension (HR, 0.83; 95% CI, 0.70-1.00; P = .68 for interaction of treatment with baseline orthostatic hypotension). More intensive BP treatment or active therapy lowered risk of CVD or all-cause mortality among those without baseline standing hypotension (HR, 0.80; 95% CI, 0.75-0.85), and nonsignificantly among those with baseline standing hypotension (HR, 0.94; 95% CI, 0.75-1.18). Effects did not differ by baseline standing hypotension (P = .16 for interaction of treatment with baseline standing hypotension). Conclusions and Relevance: In this population of hypertension trial participants, intensive therapy reduced risk of CVD or all-cause mortality regardless of orthostatic hypotension without evidence for different effects among those with standing hypotension.
Databáze:	MEDLINE
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