RT Journal Article
A1 Byrd, James Brian
A1 Bisognano, John D.
A1 Brook, Robert D.
T1 Treating Hypertension in Patients With Orthostatic Hypotension: Benefits vs Harms in the Era of Aggressive Blood Pressure Lowering
JF JAMA
JO JAMA
YR 2023
DO 10.1001/jama.2023.19096
VO 330
IS 15
SP 1435
OP 1436
SN 0098-7484
AB Health care professionals are right to be concerned when a patient’s blood pressure (BP) decreases upon standing, and to wonder about the cause, the potential adverse consequences, and the appropriate course of action. Orthostatic hypotension (OH) is objectively confirmed when the systolic or diastolic BP decreases by 20 mm Hg or more and/or 10 mm Hg or more, respectively, 3 minutes after standing upright. More stringent criteria (ie, ≥30/15 mm Hg) have been proposed for patients with hypertension as the magnitude of BP decrease is dependent on baseline levels. Regardless of exact thresholds, the presence of OH is important to uncover because it can be both a marker and a mediator of increased morbidity and mortality. It is also common, affecting between 5% and 30% of adults depending on a number of factors, notably age. Beyond direct risks posed by the decrease in BP (eg, syncope), a number of underlying conditions (eg, frailty, autonomic failure) also contribute to excess mortality. Standing hypotension, on the other hand, is a different clinical phenomenon that poses less clear risk. It has been variably defined as an upright BP below an arbitrary threshold, often corresponding with a normal seated BP.
RD 5/20/2024
UL https://doi.org/10.1001/jama.2023.19096