Syncope, Hypotension, and Falls in the Treatment of Hypertension: Results from the Randomized Clinical Systolic Blood Pressure Intervention Trial
Open accessAbstract
Objective: To determine predictors of serious adverse events ( SAE s) involving syncope, hypotension, and falls, with particular attention to age, in the Systolic Blood Pressure Intervention Trial. Design: Randomized clinical trial. Setting: Academic and private practices across the United States (N = 102). Participants: Adults aged 50 and older with a systolic blood pressure ( SBP ) of 130 to 180 mmHg at high risk of cardiovascular disease events, but without diabetes, history of stroke, symptomatic heart failure or ejection fraction less than 35%, dementia, or standing SBP less than 110 mmHg (N = 9,361). Intervention: Treatment of SBP to a goal of less than 120 mmHg or 140 mmHg. Measurements: Outcomes were SAE s involving syncope, hypotension, and falls. Predictors were treatment assignment, demographic characteristics, comorbidities, baseline measurements, and baseline use of cardiovascular medications. Results: One hundred seventy‐two (1.8%) participants had SAE s involving syncope, 155 (1.6%) hypotension, and 203 (2.2%) falls. Randomization to intensive SBP control was associated with greater risk of an SAE involving hypotension (hazard ratio ( HR ) = 1.67, 95% confidence interval ( CI ) = 1.21–2.32, P = .002), and possibly syncope ( HR = 1.32, 95% CI = 0.98–1.79, P = .07), but not falls ( HR = 0.98, 95% CI = 0.75–1.29, P = .90). Risk of all three outcomes was higher for participants with chronic kidney disease or frailty. Older age was also associated with greater risk of syncope, hypotension, and falls, but there was no age‐by‐treatment interaction for any of the SAE outcomes. Conclusions: Participants randomized to intensive SBP control had greater risk of hypotension and possibly syncope, but not falls. The greater risk of developing these events associated with intensive treatment did not vary according to age.
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Older individuals and those with CKD and frailty have been shown to be at higher risk of adverse effects of intensive blood pressure management.
“Older individuals and those with CKD and frailty have been shown to be at higher risk of adverse effects of intensive blood pressure management (49).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [49]
The Results (page unavailable in our copy) report higher risks of serious adverse events involving syncope, hypotension, and falls among participants with CKD or frailty and among older participants. But those are higher event risks, not evidence that intensive treatment caused a greater increase in risk in these groups: the Results found no treatment interaction by age or frailty. Intensive treatment increased hypotension risk overall, possibly increased syncope risk, and did not increase falls. (LLM, conf=0.88)
Experimental — accuracy not yet measuredIn SPRINT, the intensive systolic blood pressure target reduced the risk of death by 27%.
“Intensive target reduced risk of death 27%”
From 10. Cardiovascular Disease and Risk Management: <i>Standards of Care in Diabetes—2023</i> (2023) · cites this paper as [43]
Individuals with older age, chronic kidney disease, and frailty have been shown to be at higher risk of adverse effects of intensive blood pressure control.
“Individuals with older age, CKD, and frailty have been shown to be at higher risk of adverse effects of intensive blood pressure control (43).”
From 10. Cardiovascular Disease and Risk Management: <i>Standards of Care in Diabetes—2023</i> (2023) · cites this paper as [43]
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- Authors
- Sink, K. M., Evans, G. W., Shorr, R. I., Bates, J. T., Berlowitz, D., Conroy, M. B., Felton, D. M., Gure, T., Johnson, K. C., Kitzman, D., Lyles, M. F., Servilla, K., Supiano, M. A., Whittle, J., Wiggers, A., & Fine, L. J.
- Affiliations
- Wake Forest University Health Sciences (US)
- University of Florida Health (US)
- Michael E. DeBakey VA Medical Center (US)
- Boston University (US)
- University of Utah (US)
- The Ohio State University Wexner Medical Center (US)
- University of Tennessee Health Science Center (US)
- Raymond G. Murphy VA Medical Center (US)
- Medical College of Wisconsin (US)
- Ohio University (US)
- National Institutes of Health (US)
- Corresponding author
- Sink, Kaycee M.
- ORCID
- Venue
- Journal of the American Geriatrics Society
- Publisher
- Wiley
- Published
- 2018-03-30
- Volume
- 66
- Issue
- 4
- Pages
- 679-686
- ISSN
- 0002-8614 (ISSN-L)
- 1532-5415
- PMC
- PMC8045467
- OpenAlex
- W2795314541
- Cited by
- 92
- References
- 18
- Citations by year
- 2026: 4 · 2025: 10 · 2024: 10 · 2023: 7 · 2022: 11 · 2021: 17 · 2020: 15 · 2019: 11 · 2018: 7
- FWCI
- 9.44
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Geriatrics Society (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health
- National Heart, Lung, and Blood Institute
- National Institute of Diabetes and Digestive and Kidney Diseases
- National Institute on Aging
- National Institute of Neurological Disorders and Stroke (HHSN268200900040C, HHSN268200900046C, HHSN268200900047C, HHSN268200900048C, HHSN268200900049C)
- Case Western Reserve University (UL1TR000439)
- Ohio State University (UL1RR025755)
- University of Pennsylvania (UL1RR024134, UL1TR000003)
- Boston University (UL1RR025771)
- Stanford University (UL1TR000093)
- Tufts University (UL1RR025752, UL1TR000073, UL1TR001064)
- University of Illinois (UL1TR000050)
- University of Pittsburgh (UL1TR000005)
- University of Texas Southwestern Medical Center (9U54TR000017–06)
- University of Utah (UL1TR000105–05)
- Vanderbilt University (UL1 TR000445)
- George Washington University (UL1TR000075)
- University of California, Davis (UL1 TR000002)
- University of Florida (UL1 TR000064)
- University of Michigan (UL1TR000433)
- Wake Forest University (UL1TR001420)
- Tulane University (P30GM103337)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Keywords
- hypertension, intensive blood pressure control, systolic blood pressure, syncope, hypotension, falls, adverse events, older adults, chronic kidney disease, frailty, age, cardiovascular risk
- MeSH terms
- Accidental Falls, Adult, Aged, Aged, 80 and over, Antihypertensive Agents, Blood Pressure, Cardiovascular Diseases, Female, Humans, Hypertension, Hypotension, Male, Middle Aged, Risk Factors, Syncope, Time Factors, Comorbidity
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