Orthostatic Hypotension, Cardiovascular Outcomes, and Adverse Events: Results From SPRINT

Hypertension. 2020 Mar;75(3):660-667. doi: 10.1161/HYPERTENSIONAHA.119.14309. Epub 2020 Jan 27.


Orthostatic hypotension (OH) is frequently observed with hypertension treatment, but its contribution to adverse outcomes is unknown. The SPRINT (Systolic Blood Pressure Intervention Trial) was a randomized trial of adults, age ≥50 years at high risk for cardiovascular disease with a seated systolic blood pressure (BP) of 130 to 180 mm Hg and a standing systolic BP ≥110 mm Hg. Participants were randomized to a systolic BP treatment goal of either <120 or <140 mm Hg. OH was defined as a drop in systolic BP ≥20 or diastolic BP ≥10 mm Hg 1 minute after standing from a seated position. We used Cox models to examine the association of OH with cardiovascular disease or adverse study events by randomized BP goal. During the follow-up period (median 3years), there were 1170 (5.7%) instances of OH among those assigned a standard BP goal and 1057 (5.0%) among those assigned the intensive BP goal. OH was not associated with higher risk of cardiovascular disease events (primary outcome: hazard ratio 1.06 [95% CI, 0.78-1.44]). Moreover, OH was not associated with syncope, electrolyte abnormalities, injurious falls, or acute renal failure. OH was associated with hypotension-related hospitalizations or emergency department visits (hazard ratio, 1.77 [95% CI, 1.11-2.82]) and bradycardia (hazard ratio, 1.94 [95% CI, 1.19-3.15]), but these associations did not differ by BP treatment goal. OH was not associated with a higher risk of cardiovascular disease events, and BP treatment goal had no effect on OH's association with hypotension and bradycardia. Symptomless OH during hypertension treatment should not be viewed as a reason to down-titrate therapy even in the setting of a lower BP goal. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT01206062.

Keywords: blood pressure; cardiovascular disease; hypertension; orthostatic hypotension; syncope.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Aged
  • Antihypertensive Agents / administration & dosage
  • Antihypertensive Agents / adverse effects*
  • Antihypertensive Agents / therapeutic use
  • Asymptomatic Diseases
  • Blood Pressure
  • Bradycardia / chemically induced
  • Bradycardia / epidemiology
  • Cardiovascular Diseases / epidemiology
  • Comorbidity
  • Female
  • Follow-Up Studies
  • Goals
  • Humans
  • Hypertension / drug therapy*
  • Hypertension / epidemiology
  • Hypotension / chemically induced
  • Hypotension / epidemiology
  • Hypotension, Orthostatic / chemically induced
  • Hypotension, Orthostatic / epidemiology*
  • Male
  • Middle Aged
  • Proportional Hazards Models
  • Racial Groups / statistics & numerical data
  • Renal Insufficiency, Chronic / epidemiology
  • Risk


  • Antihypertensive Agents

Associated data

  • ClinicalTrials.gov/NCT01206062