What question did this study set out to answer?

This research aims to clarify how decreases in systolic and diastolic blood pressure during orthostasis relate to cardiovascular events in hypertensive patients.

September 21, 2013Journal of Hypertension

Systolic and diastolic component of orthostatic hypotension and cardiovascular events in hypertensive patients

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Why the study?

Does systolic or diastolic orthostatic hypotension predict different cardiovascular events in treated hypertensive patients?

Population

8788 treated hypertensive patients without history of MI or stroke at baseline, 52.2% men, mean age 52…

Comparison

Orthostatic hypotension vs Absence of orthostatic hypotension

Design

Cohort

Authors

AFArtur FedorowskiElectrophysiology BWBjörn WahlstrandUniversity of Gothenburg THThomas HednerGeneral / Preventive / Lipids

Discussion

Member takes

Implication

May signal differential stroke versus MI risks in treated hypertensives; hypothesis-generating for orthostatic screening until confirmed prospectively.

Key Points

This research aims to clarify how decreases in systolic and diastolic blood pressure during orthostasis relate to cardiovascular events in hypertensive patients.
Prospective assessment of 8788 treated hypertensive patients without prior MI or stroke.
Defined orthostatic hypotension by international consensus criteria measuring SBP and DBP changes during standing.
Analyzed data using Cox regression, adjusting for age, sex, diabetes, cholesterol, and smoking.
12.1% of participants met combined orthostatic hypotension criteria, predicting major cardiovascular events and mortality.
Systolic orthostatic hypotension had a hazard ratio of 1.53 (1.08-2.15, P=0.015) for stroke, while diastolic had a hazard ratio of 2.04 (1.20-3.46, P=0.008) for MI.
The composite endpoint showed a tendency towards significance for both types of hypotension with hazard ratios around 1.24.

Structured PICO

Does systolic or diastolic orthostatic hypotension predict different cardiovascular events in treated hypertensive patients?

Population

8788 treated hypertensive patients without history of MI or stroke at baseline, 52.2% men, mean age 52 years, mean BP 161/99 mmHg.

Intervention

Orthostatic hypotension (systolic decrease ≥20 mmHg or diastolic decrease ≥10 mmHg)

Comparator

Absence of orthostatic hypotension

Outcome

Mortality and major cardiovascular events (myocardial infarction and stroke)hard clinical

In hypertensive patients, a systolic blood pressure fall during orthostasis indicates a higher risk of stroke, whereas a diastolic fall confers a higher risk of myocardial infarction.

Cite This Study

Fedorowski et al. (2013) studied this question.

synapsesocial.com/papers/6a199a50a2165c1276decd8b https://doi.org/10.1097/hjh.0b013e328365cd59

Topics

Hypertension management

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Implication

May signal differential stroke versus MI risks in treated hypertensives; hypothesis-generating for orthostatic screening until confirmed prospectively.

Systolic and diastolic component of orthostatic hypotension and cardiovascular events in hypertensive patients

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

Systolic and diastolic component of orthostatic hypotension and cardiovascular events in hypertensive patients

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

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Topics

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