Effects of intensive blood pressure treatment on orthostatic hypertension: individual level meta-analysis

作者：Stephen P. Juraschek, Jiun‐Ruey Hu, Jennifer Cluett, Carol Mita, Lewis A. Lipsitz, Lawrence J. Appel, Nigel Beckett, Barry R Davis, Rury R. Holman, Edgar R. Miller, Kenneth J. Mukamal, Ruth Peters, Jan A. Staessen, Addison A. Taylor, Jackson T. Wright, William C. Cushman · 发表于：BMJ · 年份：2025 · DOI：10.1136/bmj-2024-080507 · 被引用次数：6 · 研究领域：Cardiovascular Syncope and Autonomic Disorders、Heart Rate Variability and Autonomic Control、Heart rate and cardiovascular health

Abstract Objective To determine the effects of intensive blood pressure treatment on orthostatic hypertension. Design Systematic review and individual participant data meta-analysis. Data sources MEDLINE, Embase, and Cochrane CENTRAL databases through 13 November 2023. Inclusion criteria Population: ≥500 adults, age ≥18 years with hypertension or elevated blood pressure; intervention: randomized trials of more intensive antihypertensive drug treatment (lower blood pressure goal or active agent) with duration ≥6 months; control: less intensive antihypertensive drug treatment (higher blood pressure goal or placebo); outcome: measured standing blood pressure. Main outcomes Orthostatic hypertension, defined as an increase in systolic blood pressure ≥20 mm Hg or diastolic blood pressure ≥10 mm Hg after changing from sitting to standing. Data synthesis Two investigators independently abstracted articles. Individual participant data from nine trials identified during the systematic review were appended together as a single dataset. Results Of 31 124 participants with 315 497 standing blood pressure assessments, 9% had orthostatic hypotension (that is, a drop in blood pressure after standing of systolic ≥20 mm Hg or diastolic ≥10 mm Hg), 17% had orthostatic hypertension, and 3.2% had both a rise in systolic blood pressure and standing blood pressure ≥140 mm Hg at baseline. The effects of more intensive treatment were similar across trials with odds ratios for orthostatic hypertension...