Boston—One of the primary concerns in prescribing more intensive treatment to lower blood pressure (BP) is the perceived risk of falling in older adults who become dizzy.

A study presented at the American Heart Association’s Hypertension 2019 Scientific Sessions in New Orleans suggests, however, that those patients were less likely to experience drastic BP drops.

Background information in the study notes that lower systolic BP (SBP) treatment goals reduce risk of orthostatic hypotension (OH), but whether a lower goal also reduces orthostatic symptoms remained unknown.

Researchers from Harvard Medical School and Beth Israel Deaconess Medical Center sought to determine the effect of SBP goal on OH in Secondary Prevention of Small Subcortical Strokes—Blood Pressure (SPS3-BP), an open label, randomized trial. Orthostatic hypertension was defined as a drop in SBP ≥20 mmHg or diastolic BP (DBP) ≥10 mmHg.

“Falls can be devastating in this older population,” explained lead study author Stephen Juraschek, MD, PhD, an assistant professor of medicine at Harvard Medical School and an internal medicine physician at Beth Israel Deaconess Medical Center in Boston, Mass. “As a result, there is substantial concern about anything that might increase their fall risk.

However, our study provides strong evidence that intense blood pressure treatment does not induce orthostatic hypotension or its symptoms.”

To determine that, the study team assigned adults with a recent stroke, defined as occurring in the past 6 months to either an SBP goal of 130 to 149 mmHg or less than 130 mmHg. During follow-up, researchers measured BP three times in a seated position and once after 2 minutes of standing.

Also measured were extreme standing BP values (SBP ≥190 mmHg or ≤90 mmHg; DBP ≥110mmHg or ≤40 mmHg), and participants were questioned about dizziness and lightheadedness in the process of standing up.

The study found that, during 36,342 visits involving 2,876 participants (mean age 62.8 ± 10.7 years, 37% women, 16% black) with a mean of 15 follow-up visits, OH was present 2,591 times in 1,165 participants.

At the same time, dizziness was reported 1,343 times (in 592 participants) and lightheadedness was present 941 times (in 893 participants).

“A lower SBP goal (compared to standard) was associated with a lower risk of OH (OR 0.86; 95% CI, 0.75, 0.99), a higher risk of SBP ≤90 mmHg (3.79; 2.35, 6.11) or DBP ≤40 mm Hg (2.42; 1.41, 4.15), and a lower risk of SBP ≥190 mm Hg (0.40; 0.27, 0.60) or DBP ≥110 mmHg (0.31; 0.19, 0.50),” the authors concluded, adding, “BP goal did not affect dizziness or lightheadedness.”

The study determined that a lower SBP goal decreased OH without affecting orthostatic symptoms. “These findings support recent observations that more intensive SBP treatment does not increase risk of falls,” the authors wrote.

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