Evidence mapPaperPMID 40132860Full record

SynthesisBMJ (Clinical research ed.)2025

Effects of intensive blood pressure treatment on orthostatic hypertension: individual level meta-analysis.

Stephen P Juraschek, Jiun-Ruey Hu, Jennifer L Cluett, Carol Mita, Lewis A Lipsitz, Lawrence J Appel, Nigel S Beckett, Barry R Davis, Rury R Holman, Edgar R Miller and 6 more

Abstract readMeta-AnalysisSystematic Review
In one paragraph

Synthesis in BMJ (Clinical research ed.), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors.

Stephen P JuraschekBeth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA sjurasch@bidmc.harvard.edu.ORCID 0000-0003-4168-2696
Jiun-Ruey HuDepartment of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.ORCID 0000-0003-1390-508X
Jennifer L CluettBeth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.ORCID 0000-0002-5744-1099
Carol MitaCountway Library, Harvard University, Boston, MA, USA.ORCID 0000-0003-3059-1369
Lewis A LipsitzBeth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Lawrence J AppelJohns Hopkins University, Baltimore, MA, USA.
Nigel S BeckettDepartment of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Barry R DavisDepartment of Biostatistics and Data Science, Coordinating Center for Clinical Trials, The University of Texas School of Public Health, Houston, TX, USA.ORCID 0000-0002-6493-5673
Rury R HolmanDiabetes Trials Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.
Edgar R MillerJohns Hopkins University, Baltimore, MA, USA.
Kenneth J MukamalBeth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Ruth PetersThe George Institute for Global Health, Sydney, NSW, Australia.
Jan A StaessenAlliance for the Promotion of Preventive Medicine (APPREMED), Mechelen, Belgium.ORCID 0000-0002-3026-1637
Addison A TaylorMichael E DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, USA.ORCID 0000-0003-3788-3137
Jackson T WrightCase Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
William C CushmanUniversity of Tennessee Health Science Center, Memphis, TN, USA.ORCID 0000-0001-7162-2972

Funding

NIH National Institutes of Health NHLBI /National Heart, Lung, and Blood Institute (NIH/NHLBI) K23-HL135273NIH National Institutes of Health NHLBI /National Heart, Lung, and Blood Institute (NIH/NHLBI) R01-HL153191
6 · The paper itself

Abstract

objectiveTo determine the effects of intensive blood pressure treatment on orthostatic hypertension.

designSystematic review and individual participant data meta-analysis. DATA SOURCES: MEDLINE, Embase, and Cochrane CENTRAL databases through 13 November 2023. INCLUSION CRITERIA: Population: ≥500 adults, age ≥18 years with hypertension or elevated blood pressure; intervention: randomized trials of more intensive antihypertensive drug treatment (lower blood pressure goal or active agent) with duration ≥6 months; control: less intensive antihypertensive drug treatment (higher blood pressure goal or placebo); outcome: measured standing blood pressure. MAIN OUTCOMES: Orthostatic hypertension, defined as an increase in systolic blood pressure ≥20 mm Hg or diastolic blood pressure ≥10 mm Hg after changing from sitting to standing. DATA SYNTHESIS: Two investigators independently abstracted articles. Individual participant data from nine trials identified during the systematic review were appended together as a single dataset.

resultsOf 31 124 participants with 315 497 standing blood pressure assessments, 9% had orthostatic hypotension (that is, a drop in blood pressure after standing of systolic ≥20 mm Hg or diastolic ≥10 mm Hg), 17% had orthostatic hypertension, and 3.2% had both a rise in systolic blood pressure and standing blood pressure ≥140 mm Hg at baseline. The effects of more intensive treatment were similar across trials with odds ratios for orthostatic hypertension ranging from 0.85 to 1.08 (I

conclusionsIn this pooled cohort of adults with elevated blood pressure or hypertension, orthostatic hypertension was common and more intensive blood pressure treatment modestly reduced the occurrence of orthostatic hypertension. These findings suggest that approaches generally used for seated hypertension may also prevent hypertension on standing. STUDY REGISTRATION: Prospero CRD42020153753 (original proposal).

Indexed as

Antihypertensive AgentsBlood PressureHypertensionHypotension, OrthostaticHumansRandomized Controlled Trials as TopicAntihypertensive Agents

Identifiers

PMID40132860
PMCPMC11934097

What Socratic holds

Textmetadata
LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.