{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T23:37:17Z","timestamp":1792798637530,"version":"4.5.0"},"reference-count":34,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"S.P.J","award":["R01HL153191"],"award-info":[{"award-number":["R01HL153191"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Orthostatic hypotension (OH) and orthostatic hypertension (OHT) are common among adults with hypertension and may complicate antihypertensive treatment selection. However, the impact of specific antihypertensive agents on orthostatic blood pressure (BP) responses and risk of OH or OHT remains incompletely characterized.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a secondary analysis of the Treatment of Mild Hypertension Study (TOMHS), a multicenter randomized clinical trial (1987-93). A total of 902 adults aged 45-69 years with diastolic BP 90-99 mm Hg were randomized to acebutolol, amlodipine, chlorthalidone, doxazosin, enalapril, or placebo. Orthostatic BP change (standing\u2009\u2212\u2009seated BP) was assessed at randomization, 1 month, and every 3 months up to 54 months. OH was defined as a systolic BP decrease \u226520 mm Hg or diastolic BP decrease \u226510 mm Hg; OHT was defined as a systolic BP increase \u226520 mm Hg or diastolic BP increase \u226510 mm Hg. Generalized estimating equations evaluated associations between agents and orthostatic BP changes overall, by baseline BP, and over time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 897 participants with orthostatic BP measurements (mean age 54.8 years; 38.5% female; 19.6% Black), doxazosin increased odds of OH (OR 1.45; 95% CI, 1.05-2.02) and reduced odds of OHT (OR 0.66; 95% CI, 0.51-0.86) versus placebo. Chlorthalidone reduced OHT among participants with baseline OHT (P\u2009=\u2009.018). Amlodipine and doxazosin attenuated orthostatic systolic BP changes across baseline orthostatic BP change strata. Over time, amlodipine and chlorthalidone reduced odds of OH (P\u2009=\u2009.001, 0.044).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Specific antihypertensive agents demonstrated distinct effects on orthostatic BP regulation. Consideration of orthostatic effects during antihypertensive selection may help individualize therapy, improve hemodynamic stability, and optimize treatment for patients at risk of orthostatic dysregulation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ajh\/hpag119","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T12:03:38Z","timestamp":1790769818000},"source":"Crossref","is-referenced-by-count":0,"title":["Effects of anti-hypertensive agents on orthostatic changes: secondary analysis of the Treatment of Mild Hypertension Study"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-8423-4466","authenticated-orcid":false,"given":"Esther Y","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Medicine, Beth Israel Deaconess Medical Center , Boston, MA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Medicine, Beth Israel Deaconess Medical Center , Boston, MA,","place":["United States"]},{"name":"Harvard Medical School, Harvard University , Boston, MA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Md Marufuzzaman","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Medicine, Beth Israel Deaconess Medical Center , Boston, MA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aldis","family":"Petriceks","sequence":"additional","affiliation":[{"name":"Department of Medicine, Beth Israel Deaconess Medical Center , Boston, MA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2382-1632","authenticated-orcid":false,"given":"Hannah","family":"Col","sequence":"additional","affiliation":[{"name":"Department of Medicine, Beth Israel Deaconess Medical Center , Boston, MA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3628-0983","authenticated-orcid":false,"given":"Mingyu","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Medicine, Beth Israel Deaconess Medical Center , Boston, MA,","place":["United States"]},{"name":"Harvard Medical School, Harvard University , Boston, MA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Long H","family":"Ngo","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Harvard University , Boston, MA,","place":["United States"]},{"name":"Harvard T.H. 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