Page 4 - hypertension_newsletter3

REFLECTIONS rtensio n
Hypertension Global Newsletter #3 Hype
n oisnetr
CLINICAL PEARLS FROM THE FACULTY It is not yet known whether the management of hypertensioHny,pe
including treatment goals, and choice and dosages of
WATCH antihypertensive drugs, should be managed differently in men
PROF. TSABEDZE DISCUSS HIS and women. The authors suggest that future clinical studies
THOUGHTS ON THE SIGNIFICANCE should explore several sex-related differences, including:
OF THE ESC STATEMENT ON
SEX DIFFERENCES TO • Better understanding of the underlying mechanisms of
CLINICAL PRACTICE the BP increase in midlife to provide targets for improved
CLICK HERE prevention of hypertension in both sexes
FOR THE LINK TO FULL ARTICLE
• Better integration of sex differences in risk assessment tools
to improve CVD prevention

• Identifying underlying mechanisms for sex differences in
HMOD for better targets to reduce high-risk phenotypes and
progression to CVD

• Explore if different diagnostic BP threshold values or
treatment targets may improve CVD prevention

• Examine and communicate sex differences in the efficacy
and adverse effects of antihypertensive treatment to
optimize therapy

Orthostatic hypotension and mortality risk in geriatric outpatients: The impact of
duration and magnitude of the blood pressure drop.

Wiersinga JHI, et al. J Hypertens. 2022 Jun 1;40(6):1107-1114.

Orthostatic hypotension, a drop in BP after standing up, is a common condition affecting older persons (10–35%) and is associated
with an increased mortality risk. This observational prospective cohort study aimed to investigate the prevalence and magnitude of
orthostatic hypotension and determine its association with mortality in a geriatric outpatient population of 1240 patients (mean age
79.4 ± 6.9 years, 52.6% women).

Definitions Criteria

Orthostatic hypotension Drop in SBP =20 mm Hg and/or DBP =10 mm Hg
Early orthostatic hypotension Only at 1 min of standing up
Delayed orthostatic hypotension Only at 3 min of standing up
Prolonged orthostatic hypotension At both 1 and 3 min

Note: Groups with delayed and prolonged orthostatic hypertension were combined for analysis

The prevalence of orthostatic hypotension in this population was consistent with previous literature, 34.9% (11.9% of patients with
early orthostatic hypotension [EOH] and 23% with delayed or prolonged orthostatic hypotension [DPOH]). After a median (range)
follow-up of 1.9 (IQR 1.0–3.1) years, 22% of patients died. DPOH was associated with a higher mortality risk (age- and sex-adjusted
HR 1.69, 95% CI 1.28–2.22), whereas EOH was not associated with mortality risk. A subanalysis of geriatric patients with deficits,
such as physical impairment, cognitive impairment, malnutrition, and depressive symptoms, did not reveal a difference in the
association with mortality risk.

TABLE OF CONTENTS