Aggressive hypertension treatment does not lead to dangerous drops in blood pressure


Hypertension (high blood pressure) is one of the leading causes of death and disability worldwide. It is a primary risk factor for many medical conditions, including heart attacks, strokes, heart failure, kidney disease, atrial fibrillation, and dementia.

Blood pressure (BP) control is so critical that when the American Heart Association and the American College of Cardiology updated their treatment guidelines in 2017, they called for more aggressive blood pressure treatment. They lowered the definition of normal or optimal blood pressure to less than 120/80 mm Hg, and they recommended treatment for blood pressure above 130/80 mm Hg.

Doctors fear treating hypertension too aggressively

Doctors have always worked to optimize blood pressure, but many doctors have been reluctant to be too much aggressive. This is probably based on our Hippocratic oath of “do no harm first”. It is feared that a too aggressive drop in blood pressure could lead to symptoms of weakness and fatigue, or to lightheadedness and lightheadedness. These symptoms, especially in older patients, could lead to a fall which could lead to injury or disability.

A reduction in blood pressure with a change in position is called orthostatic hypotension. This usually happens when someone changes from a sitting position to a standing position. Most of us have felt momentary symptoms, noting dark vision after getting up too quickly. This is usually a short-lived event, lasts only a few seconds and resolves quickly. But what if these symptoms are severe enough or last long enough to be dangerous?

Intensive treatment for hypertension does not cause dangerous drops in blood pressure, study finds

A recent meta-analysis published in Annals of Internal Medicine reviewed five trials to examine the effect of intensive antihypertensive therapy and to answer the question: Does intensive blood pressure therapy cause a dangerous drop in blood pressure? The analysis included over 18,000 participants, and the quality of the studies was rated as good, with minimal variation between trials.

This meta-analysis analyzed randomized studies in which patients were assigned to either intensive blood pressure control, less intensive blood pressure control, or placebo, for at least six months. Studies have documented blood pressure readings from both sitting and standing, and standing blood pressure readings were taken after standing for at least a minute. Orthostatic hypotension was defined as a drop in sitting-to-standing blood pressure of at least 20 mm Hg systolic blood pressure (the higher number on a BP measurement) and at least 10 mm Hg or more diastolic blood pressure (the bottom number).

The study results provide an important take-home message for both patients and their physicians: Intensive lowering of blood pressure was not associated with orthostatic hypotension, and in fact intensive treatment. decreases the risk of orthostatic hypotension. These findings should give physicians peace of mind when pursuing blood pressure lowering goals.

One less worry when selecting blood pressure treatment

Since Americans have a lifetime risk of hypertension of over 80%, most people with normal blood pressure are at risk of developing high blood pressure. Regular blood pressure measurements are essential to ensure prompt treatment.

Treatment usually needs to start with lifestyle changes such as weight loss, regular exercise, and eating a healthy diet, which means limiting processed foods and sodium, working on portion control, and limiting alcohol. . These changes can have a significant impact on blood pressure, but they are not always enough. If you need medication, you and your doctor can choose a treatment without worrying about orthostatic hypotension.

Aggressive post-hypertension treatment does not lead to dangerous drops in blood pressure, first appeared on Harvard Health Blog.