Patient-Oriented Evidence That Matters

Tighter Blood Pressure Control Does Not Increase the Likelihood of Orthostatic Hypotension


Am Fam Physician. 2021 Aug ;104(2):208.

Clinical Question

Are lower blood pressure goals associated with a higher likelihood of orthostatic hypotension?

Bottom Line

Orthostatic hypotension, a drop of 20 mm Hg systolic or 10 mm Hg diastolic after moving from sitting to standing, was not associated with more intensive treatment of blood pressure and may be less likely to occur with intensive treatment. (Level of Evidence = 1a)


The authors assembled randomized trials from three databases, including Cochrane CENTRAL, that compared intensive goals with less intensive goals for blood pressure treatment. They included studies written in any language. Two investigators independently abstracted the articles and evaluated them for quality. All studies were open label, and there was a risk of detection bias because investigators were aware of the patients' treatments. The studies enrolled 18,466 patients. Intensive blood pressure treatment was associated with a lower risk for orthostatic hypotension, but not by much (odds ratio = 0.93; 95% CI, 0.86 to 0.99). The likelihood of orthostatic hypotension was not different with active treatment compared with placebo. The effect did not differ if the patient had (or did not have) orthostatic hypotension before randomization. The original studies did not evaluate for rates of lightheadedness, syncope, or falls.

Study design: Meta-analysis (randomized controlled trials)

Funding source: Government

Setting: Various (meta-analysis)

Reference: Juraschek SP, Hu J-R, Cluett JL, et al. Effects of intensive blood pressure treatment on orthostatic hypotension: a systematic review and individual participant-based meta-analysis. Ann Intern Med. 2021;174(1):58–68.

Editor's Note: Dr. Shaughnessy is an assistant medical editor for AFP.

POEMs (patient-oriented evidence that matters) are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

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This series is coordinated by Sumi Sexton, MD, editor-in-chief.

A collection of POEMs published in AFP is available at https://www.aafp.org/afp/poems.



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