Effects of intensive blood pressure treatment on orthostatic hypertension: individual level meta-analysis.

Methods

Systematic reviewand individual participant data meta-analysis.

系统评价和个体参与者数据的荟萃分析。

data_sources

MEDLINE, Embase, and Cochrane CENTRAL databases through 13 November 2023.

检索 MEDLINE、Embase 和 Cochrane CENTRAL 数据库至 2023 年 11 月 13 日。

inclusion_criteria

Population: ≥500 adults, age ≥18 years with hypertension or elevated blood pressure; intervention: randomized trials of more intensive antihypertensive drug treatment (lower blood pressure goal or active agent) with duration ≥6 months; control: less intensive antihypertensive drug treatment (higher blood pressure goal or placebo); outcome: measured standing blood pressure.

研究对象：≥500 名年龄≥18 岁的成人，患有高血压或血压升高；

main_outcomes

Orthostatic hypertension, defined as an increase in systolic blood pressure ≥20 mm Hg or diastolic blood pressure ≥10 mm Hg after changing from sitting to standing.

直立性高血压定义为从坐位变为站立位后收缩压增加≥20 mm Hg或舒张压增加≥10 mm Hg。

data_synthesis

Two investigators independently abstracted articles.

两位研究者独立地摘录了文章。

Individual participant data from nine trials identified during the systematic reviewwere appended together as a single dataset.

在系统性综述中识别的九项试验的个别参与者数据被合并为一个单一的数据集。

Results

Of 31 124 participants with 315 497 standing blood pressure assessments, 9% had orthostatic hypotension (that is, a drop in blood pressure after standing of systolic ≥20 mm Hg or diastolic ≥10 mm Hg), 17% had orthostatic hypertension, and 3.2% had both a rise in systolic blood pressure and standing blood pressure ≥140 mm Hg at baseline.

在31,124名参与者中，共有315,497次站立血压评估，其中9%的参与者出现直立性低血压（即站立后收缩压下降≥20毫米汞柱或舒张压下降≥10毫米汞柱），17%的参与者出现直立性高血压，而3.2%的参与者在基线时既有收缩压上升又有站立血压≥140毫米汞柱。

The effects of more intensive treatment were similar across trials with odds ratios for orthostatic hypertension ranging from 0.85 to 1.08 (I2=38.0%).

更密集治疗的效果在各试验中相似，直立性高血压的比值比在0.85到1.08之间（I2=38.0%）。

During follow-up, 17% of patients assigned to more intensive treatment had orthostatic hypertension, whereas 19% of those assigned less intensive treatment had orthostatic hypertension.

随访期间，被分配到更密集治疗的患者中有17%出现直立性高血压，而被分配到较不密集治疗的患者中有19%出现直立性高血压。

Compared with less intensive treatment, the risk of orthostatic hypertension was lower with more intensive blood pressure treatment (odds ratio 0.93, 95% confidence interval0.90 to 0.96).

与较不密集的治疗相比，更密集的血压治疗降低了直立性高血压的风险（比值比0.93，95%置信区间0.90至0.96）。

Effects were greater among non-black versus black adults (odds ratio 0.86 v 0.97; P for interaction=0.003) and adults without diabetes versus those with diabetes (0.88 v 0.96; P for interaction=0.05) but did not differ by age ≥75 years, sex, baseline seated blood pressure ≥130/≥80 mm Hg, obesity, stage 3 kidney disease, stroke, cardiovascular disease, standing systolic blood pressure ≥140 mm Hg, or pre-randomization orthostatic hypertension (P for interactions ≥0.05).

效果在非黑人成年群体中比在黑人成年群体中更为显著（比值比0.86对比0.97；交互作用P值=0.003），以及在没有糖尿病的成人中比有糖尿病的成人更为显著（0.88对比0.96；交互作用P值=0.05），但与年龄≥75岁、性别、基线坐位血压≥130/≥80 mm Hg、肥胖、3期肾病、中风、心血管疾病、站立时收缩压≥140 mm Hg或随机化前的直立性高血压无关（交互作用P值≥0.05）。

Conclusions

In this pooled cohort of adults with elevated blood pressure or hypertension, orthostatic hypertension was common and more intensive blood pressure treatment modestly reduced the occurrence of orthostatic hypertension.

在这项针对血压升高或高血压成人患者合并分析中，体位性高血压很常见，更密集的血压治疗适度降低了体位性高血压的发生率。

These findings suggest that approaches generally used for seated hypertension may also prevent hypertension on standing.

这些发现表明，通常用于坐位高血压的方法也可能预防站立时的高血压。

study_registration

Prospero CRD42020153753 (original proposal).

Prospero CRD42020153753（原始提案）。