Key result
Baseline orthostatic BP changes exhibited a U-shaped relationship with MACE, where deviations from 0 mm Hg increased risk (e.g., HR 0.99, 95% CI 0.98-1.00 for SBP decrease).
Why the study?
To evaluate the association between baseline orthostatic blood pressure change and the occurrence of major adverse cardiovascular events in patients with hypertension.
Does baseline orthostatic blood pressure change affect the risk of MACE and interact with the benefits of intensive blood pressure management in patients with hypertension?
RCT (n=9,329)
randomised
Yes
Does baseline orthostatic blood pressure change affect the risk of MACE and interact with the benefits of intensive blood pressure management in patients with hypertension?
Hazard Ratio: 0.99 (95% CI 0.98–1)
p-value: p=0.04
Orthostatic DBP increase and SBP decrease are associated with increased MACE risk, but the cardiovascular benefits of intensive BP management remain consistent regardless of baseline orthostatic BP changes.
Orthostatic BP changes may stratify MACE risk in hypertension; leaves open whether they modify intensive BP management benefits.
INTRODUCTION: The Systolic Blood Pressure Intervention Trial (SPRINT) demonstrated that closely controlling blood pressure (BP) could decrease cardiovascular outcome risk without increasing the orthostatic hypotension rate. We aimed to evaluate the association between baseline orthostatic BP change and major adverse cardiovascular event (MACE) occurrence. METHODS: We conducted a post hoc analysis using SPRINT data including 9329 patients with hypertension. The SPRINT trial was a two-arm, multicentre, randomised clinical trial designed to test whether an intensive treatment aimed at reducing systolic BP (SBP) to <120 mm Hg would reduce cardiovascular disease risk. Orthostatic BP change was defined as baseline standing systolic BP (SBP)-baseline mean seated SBP, or diastolic BP (DBP)-baseline mean seated DBP. RESULTS: We found a U-shaped relationship between orthostatic BP changes and MACE occurrence. All lowest risk points were around 0 mm Hg. On the left side of the inflection point, MACE risk decreased with orthostatic BP change decrease (HR=0.99, 95% CI (0.98 to 1.00), p=0.04, SBP change) (HR=0.97, 95% CI (0.95 to 0.99), p<0.01, DBP change); on the right side, MACE risk increased with orthostatic BP change increase (HR=1.02, 95% CI (1.01 to 1.06), p<0.01, SBP change) (HR=1.01, 95% CI (1.00 to 1.03), p=0.16, DBP change). There was no significant interaction effect between orthostatic SBP (p for interaction=0.37) or DBP changes (p for interaction=0.33) and intensive BP management. CONCLUSIONS: Orthostatic DBP increase and SBP decrease were associated with an increased MACE risk. The benefits of intensive BP management were also consistent across different orthostatic BP change ranges.
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Pei et al. (2022) conducted an RCT in hypertension (n=9,329). Orthostatic BP change vs. 0 mm Hg orthostatic BP change was evaluated on major adverse cardiovascular event (MACE) occurrence (HR 0.99, 95% CI 0.98 to 1.00, p=0.04). Baseline orthostatic BP changes exhibited a U-shaped relationship with MACE, where deviations from 0 mm Hg increased risk (e.g., HR 0.99, 95% CI 0.98-1.00 for SBP decrease).
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