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More (vs less) intensive blood pressure management leads to slightly *reduced* risk of orthostatic hypotension (OH). Important study but a few considerations for older adults…
https://www.acpjournals.org/doi/10.7326/M20-4298
Thread (1/n)
https://www.acpjournals.org/doi/10.7326/M20-4298
Thread (1/n)
Study evaluated: “If I treat BP more aggressively now, what will happen to future risk of OH?”
Did *not* evaluate “If my patient is having OH now, what should I do?”
If someone is having symptomatic OH today, still prudent to be cautious with BP meds.
2/n
Did *not* evaluate “If my patient is having OH now, what should I do?”
If someone is having symptomatic OH today, still prudent to be cautious with BP meds.
2/n
Reduced risk of OH with more aggressive treatment emerged by month 1-6. Some patients may need gentle up-titration of meds but reassuring that benefits (and lack of harms) emerge fairly quickly.
3/n
3/n
Benefits were similar in age <75 and in age >75. Nice to see this analysis but doesn’t tell us much about risk in those who are frail.
4/n
4/n
Many older adults feel woozy upon standing, but recover after several seconds. OH measurements used in study were done 1 min after standing. But OH shortly after standing picks up something different & is more clinically relevant...
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5661881/
5/n
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5661881/
5/n
... so hard to know what we are missing and how results apply to early-onset symptomatic OH.
Lots more to learn. Kudos to authors on important study. As always, should learn what we can from it but be aware of what questions remain unanswered.
6/end
Lots more to learn. Kudos to authors on important study. As always, should learn what we can from it but be aware of what questions remain unanswered.
6/end
