Effects of Intensive Blood Pressure Treatment on Orthostatic Hypotension
Effects of Intensive Blood Pressure Treatment on Orthostatic Hypotension
复制标题
强化血压治疗对体位性低血压的影响
DOI：
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发表时间：
2020
影响因子：
39.2
通讯作者：
K. Mukamal
中科院分区：
文献类型：
--
作者：
S. Juraschek;Jiun;Jennifer L. Cluett;Anthony Ishak;C. Mita;L. Lipsitz;L. Appel;N. Beckett;R. Coleman;W. Cushman;B. Davis;G. Grandits;R. Holman;E. Miller;R. Peters;J. Staessen;Addison A. Taylor;L. Thijs;J. Wright;K. Mukamal
背景
虽然强化的降压治疗可以降低心血管疾病的风险，但也有人担心它可能会导致体位性低血压。
目的
研究强化降压治疗对成人高血压患者OH的影响。（PROSPERO：CRD 42020153753）。
数据源
MEDLINE、EMBASE和科克伦CENTRAL从开始到2019年10月7日，无语言限制。
资料选择
BP药物治疗（更强化的BP目标或活性药物）的随机试验，涉及超过500名患有高血压或BP升高的成年人，持续时间为6个月或更长。试验比较组被分配到强度较低的BP目标组或安慰剂组，结果被测量为OH，定义为从坐位改变为站立位后收缩压降低20 mm Hg或更多，舒张压降低10 mm Hg或更多。
数据提取
两名研究者独立提取文章并对偏倚风险进行评级。
资料综合
5项试验检查了BP治疗目标，4项试验检查了活性药物与安慰剂。研究BP治疗目标的试验包括18466名参与者，随访127882次。试验是开放标签的，试验间效应的异质性最小。强化BP治疗降低了OH的风险（比值比，0.93 [95%CI，0.86 - 0.99]）。随机化前OH的效应无差异（相互作用P = 0.80）。在包括4项额外安慰剂对照试验的敏感性分析中，总体和亚组结果未发生变化。
限制
OH的评估是在参与者坐着（而不是仰卧）时进行的，不包括站立后的第一分钟。福尔斯和晕厥的数据不可用。
结论
强化降压治疗可降低OH风险。体位性低血压，在强化BP治疗之前或期间，不应被视为避免或降低高血压治疗的理由。
主要资金来源
美国国立卫生研究院国家心肺血液研究所。
BACKGROUND
Although intensive blood pressure (BP)-lowering treatment reduces risk for cardiovascular disease, there are concerns that it might cause orthostatic hypotension (OH).
PURPOSE
To examine the effects of intensive BP-lowering treatment on OH in hypertensive adults. (PROSPERO: CRD42020153753).
DATA SOURCES
MEDLINE, EMBASE, and Cochrane CENTRAL from inception through 7 October 2019, without language restrictions.
STUDY SELECTION
Randomized trials of BP pharmacologic treatment (more intensive BP goal or active agent) that involved more than 500 adults with hypertension or elevated BP and that were 6 months or longer in duration. Trial comparisons were groups assigned to either less intensive BP goals or placebo, and the outcome was measured OH, defined as a decrease of 20 mm Hg or more in systolic BP or 10 mm Hg or more in diastolic BP after changing position from seated to standing.
DATA EXTRACTION
Two investigators independently abstracted articles and rated risk of bias.
DATA SYNTHESIS
Five trials examined BP treatment goals, and 4 examined active agents versus placebo. Trials examining BP treatment goals included 18 466 participants with 127 882 follow-up visits. Trials were open-label, with minimal heterogeneity of effects across trials. Intensive BP treatment lowered risk for OH (odds ratio, 0.93 [95% CI, 0.86 to 0.99]). Effects did not differ by prerandomization OH (P for interaction = 0.80). In sensitivity analyses that included 4 additional placebo-controlled trials, overall and subgroup findings were unchanged.
LIMITATIONS
Assessments of OH were done while participants were seated (not supine) and did not include the first minute after standing. Data on falls and syncope were not available.
CONCLUSION
Intensive BP-lowering treatment decreases risk for OH. Orthostatic hypotension, before or in the setting of more intensive BP treatment, should not be viewed as a reason to avoid or de-escalate treatment for hypertension.
PRIMARY FUNDING SOURCE
National Heart, Lung, and Blood Institute, National Institutes of Health.
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影响因子：
3.2
作者：
Juraschek,StephenP;Lipsitz,LewisA;Beach,JenniferL;Mukamal,KennethJ
通讯作者：
Mukamal,KennethJ
影响因子：
120.7
作者：
NEATON, JD;GRIMM, RH;LIEBSON, PR
通讯作者：
LIEBSON, PR
影响因子：
39.2
作者：
Levey AS;Stevens LA;Schmid CH;Zhang YL;Castro AF 3rd;Feldman HI;Kusek JW;Eggers P;Van Lente F;Greene T;Coresh J;CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration)
通讯作者：
CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration)
影响因子：
120.7
作者：
Wright, JT;Bakris, G;Rostand, SG
通讯作者：
Rostand, SG