Although intensive blood pressure (BP) lowering treatment reduces the risk of cardiovascular disease, there are concerns that it might cause orthostatic hypotension (OH). To study the effects of intensive BP-lowering treatment on OH, in hypertensive adults, a systematic review and individual participant–based meta-analysis was conducted. The data sources of this study are MEDLINE, EMBASE, and Cochrane CENTRAL from inception through 7 October 2019. The randomized BP pharmacologic treatment (more intensive BP goal or active agent) involved more than 500 adults with hypertension or elevated BP, and that was six months or longer in duration. Trial comparisons were made by groups assigned to either less intensive BP goals or placebo.

Five trials examined BP treatment goals, and four examined active agents versus placebo. Trials examining the treatment goals involved 18,466 participants, conducted open-label, with minimal heterogeneity of effects across the trials. The sensitivity analyses that included four additional placebo-controlled trials, overall and subgroup findings were unchanged. In conclusion, intensive BP-lowering treatment decreases the risk for OH. Before or in the setting of more intensive BP treatment, orthostatic hypotension should not be viewed as a reason to avoid or de-escalate treatment for hypertension.