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Original research
Relationship between orthostatic blood pressure changes and intensive blood pressure management in patients with hypertension
  1. Junyu Pei1,2,
  2. Hao Zhang3,4,
  3. Yanan Li5,
  4. Jiafu Yan6,
  5. Keyang Zheng6,
  6. Xiaopu Wang7,
  7. Xi-Long Zheng2,
  8. Xinqun Hu8
  1. 1Department of Cardiovascular Medicine, Central South University, Changsha, Hunan, China
  2. 2Department of Biochemistry and Molecular Biology, The Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
  3. 3Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
  4. 4Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
  5. 5School of Public Health, Brown University, Providence, Rhode Island, USA
  6. 6Department of Cardiovascular Medicine, Capital Medical University, Beijing, China
  7. 7The Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
  8. 8Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
  1. Correspondence to Dr Xinqun Hu, The Second Xiangya Hospital of Central South University Department of Cardiovascular Medicine, Changsha, Hunan, China; xing5382{at}csu.edu.cn; Professor Xi-Long Zheng, Department of Biochemistry and Molecular Biology, The Libin Cardiovascular Institute of Alberta, The University of Calgary, Health Sciences Centre, Calgary, Alberta, Canada; xlzheng{at}ucalgary.ca

Abstract

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.

  • hypertension

Data availability statement

Data may be obtained from a third party and are not publicly available. We obtained the anonymised data and materials of the SPRINT from the National Heart, Lung, and Blood Institute BioLINCC. The data can be accessed on reasonable request at https://biolincc.nhlbi.nih.gov/studies/sprint/.

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Data availability statement

Data may be obtained from a third party and are not publicly available. We obtained the anonymised data and materials of the SPRINT from the National Heart, Lung, and Blood Institute BioLINCC. The data can be accessed on reasonable request at https://biolincc.nhlbi.nih.gov/studies/sprint/.

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Footnotes

  • Contributors XH was the guarantor for this study. XH, X-LZ and JP designed the study and provided methodological expertise. JP drafted the manuscript. HZ, YL, JY, KZ and XW drafted the tables and figures and performed the statistical analysis. All authors read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.