Abstract P032: Body Position And The Effects Of Active Hypertension Treatment On Orthostatic Hypotension: Results From The SYS-EUR Trial

Abstract

Background: We recently demonstrated that more intensive BP treatment lowered risk of orthostatic hypotension (OH) measured with a seated-to-standing protocol. However, seated-to-standing OH assessments are less sensitive than supine-to-standing and could miss clinically relevant OH. Objectives: Using data from the Systolic Hypertension in Europe (SYS-EUR) trial, we examined the effect of active hypertension treatment (vs placebo) on OH based on the difference in BP from 3 body positions (supine, seated, or standing). Methods: SYS-EUR was a multi-center, randomized trial that enrolled adults with isolated systolic hypertension (systolic blood pressure 160-219 mmHg, diastolic blood pressure<95 mmHg). Participants underwent blood pressure measurement in three positions: supine, seated, and standing. Using differences in BP between the 3 body positions (seated minus supine, standing minus seated, and standing minus supine), we defined OH as a drop in SBP≥20 mm Hg or DBP ≥10 mm Hg. Results: Among 4,673 participants (mean age 70.2 ± 6.7 yrs, 66.9% female) with 43,809 BP measurements, OH was present in 6.4% of measures with supine-to-seated, 4.3% with seated-to-standing, and 9.8% with supine-to-standing protocols, respectively ( Figure ). Compared with placebo, active BP treatment was not associated with OH, ORs being 0.81 (95% CI: 0.63, 1.04) with seated-to standing, 0.96 (95% CI: 0.73, 1.26) with supine-to-seated, and 1.00 (95% CI: 0.82, 1.21) with supine-to-standing protocols. Conclusion: Regardless of protocol, active hypertension treatment did not increase risk of OH, reinforcing evidence that OH should not be viewed as a complication of hypertension treatment.