Hypertension (high blood pressure) is a leading cause of death and disability worldwide. It is a major risk factor for numerous conditions including heart attack, stroke, heart failure, kidney disease, atrial fibrillation, and dementia.
Blood pressure 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 management. They lowered the definition of normal or optimal blood pressure to less than 120/80 mm Hg and recommended treatment for blood pressure greater than 130/80 mm Hg.
Doctors worry about treating high blood pressure too aggressively
Doctors have worked to optimize blood pressure in the past, but many doctors have been reluctant to do so excessively aggressive. This is likely based on our Hippocratic oath “firstly, do no harm”. There is concern that lowering blood pressure too aggressively could lead to symptoms of weakness and fatigue or lightheadedness and dizziness. These symptoms, especially in the elderly, can lead to a fall, which could result in injury or disability.
A decrease in blood pressure with a change in position is called orthostatic hypotension. It usually occurs when someone is going from sitting to standing. Most of us have experienced temporary symptoms and noticed dark eyesight after standing up too quickly. This is usually a short-lived event that lasts for seconds and resolves quickly. But what if these symptoms were severe enough or lasted long enough to be dangerous?
The study found that intensive treatment for high blood pressure did not cause dangerous drops in blood pressure
A recently published meta-analysis in Internal Medicine Annals reviewed five studies to examine the effects of intensive antihypertensive treatment and to answer the question: Does intensive blood pressure treatment cause a dangerous drop in blood pressure? The analysis included over 18,000 participants and the study quality was rated as good with minimal variation between studies.
This meta-analysis analyzed randomized trials in which patients were assigned either intensive blood pressure control, less intensive blood pressure control, or placebo for at least six months. The studies documented both sitting and standing blood pressure values, and standing blood pressure values were measured after standing for at least one minute. Orthostatic hypotension was defined as a fall in sedentary blood pressure from sitting to standing from at least 20 mm Hg systolic blood pressure (the highest number in a blood pressure reading) and at least 10 or more mm Hg diastolic blood pressure (the bottom number).
The results of the study provide an important takeaway message for both patients and their physicians: intensive blood pressure reduction was not associated with orthostatic hypotension, and in fact intensive treatment was required decreased the risk of orthostatic hypotension. These results should reassure doctors as they aim for lower blood pressure goals.
One less thing to worry about when choosing a blood pressure treatment
Given that Americans have a lifetime risk of high blood pressure greater than 80%, most people with normal blood pressure are likely to develop high blood pressure at some point. Regular blood pressure measurements are essential to ensure prompt treatment.
Treatment should usually begin with lifestyle changes like weight loss, regular exercise, and 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 are not always enough. If you need medication, you and your doctor can choose a treatment without worrying about orthostatic hypotension.