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Citation
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Kondo JK, Earle W, Turkson-Ocran RAN, Ngo LH, Cluett JL, Lipsitz LA, Daya NR, Selvin E, Lutsey PL, Coresh J, Windham BG, Kendrick KN, Juraschek SP. Am. J. Hypertens. 2023; ePub(ePub): ePub. |
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Abstract
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BACKGROUND: ACC/AHA guidelines caution against the use of antihypertensive therapy in the setting of low standing systolic BP (SBP) <110 mmHg due to unclear benefits.
METHODS: The Atherosclerosis Risk in Communities (ARIC) Study measured supine and standing SBP in adults aged 45-64 years between 1987-1989. We used Cox regression to evaluate the associations of low standing SBP (<110 mmHg) with risk of falls, syncope, coronary heart disease (CHD), and mortality through December 31, 2019. Falls and syncope were ascertained by hospitalization and outpatient claims; CHD events were adjudicated. Associations were examined overall and in strata of hypertension stage, 10-year atherosclerotic cardiovascular disease (ASCVD) risk, age, and sex.
RESULTS: Among 12,467 adults followed a median of 24 years (mean age at enrollment 54.1±5.8 years, 55% women, 26% Black adults), 3000 (24%) had a standing SBP <110 mmHg. A standing SBP <110 mmHg compared to standing SBP ≥110 mmHg was not significantly associated with falls or syncope, and was associated with a lower risk of CHD events and mortality with HRs of 1.02 (95% CI 0.94, 1.11), 1.02 (0.93, 1.11), 0.88 (0.80, 0.97), and 0.91 (0.86, 0.97), respectively. There were no clinically meaningful differences when stratified by hypertension stage, 10-year ASCVD risk, age, and sex.
CONCLUSIONS: In this community-based population, low standing SBP was common and not significantly associated with falls or syncope, but was associated with a lower risk of CHD and mortality. These findings do not support screening for low standing BP as a risk factor for adverse events.
Language: en |