Hale W A, Chambliss M L
Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, USA.
J Fam Pract. 1999 Jul;48(7):547-52.
Primary care physicians test for orthostatic hypotension to find risk factors they can modify. By doing so, they may prevent adverse outcomes related to falls and ischemic organ injury due to hypoperfusion. Varied recommendations have been made regarding which patients to test, measurement methods, and the definition of a clinically significant postural decline in blood pressure.
We identified research articles relating to orthostatic hypotension by doing a literature review. Eleven articles were selected on the basis of quality of research methods and applicability to primary care practice from which prevalence, associated factors, and outcomes related to orthostatic hypotension were reported.
The prevalence of orthostatic hypotension varied from 13% to 30.3% in elderly patients. Hypertension was the most consistently associated diagnosis. Two of 3 studies did not find an association between orthostatic hypotension and mortality, and the third found that association only in patients with diabetes and hypertension.
The information available does not support postural blood pressure testing as a screening device among patients attending primary care practices. However, there is evidence to support the testing of high-risk subgroups of patients. Answers to the proposed research questions will clarify how testing for orthostatic hypotension can be most effectively applied in primary care.
基层医疗医生检测直立性低血压以找出他们能够改变的风险因素。通过这样做，他们可能预防与跌倒以及因灌注不足导致的缺血性器官损伤相关的不良后果。关于检测哪些患者、测量方法以及临床上有意义的体位性血压下降的定义，已经有了各种各样的建议。
我们通过文献综述确定了与直立性低血压相关的研究文章。基于研究方法的质量和对基层医疗实践的适用性，从其中选出了11篇文章，这些文章报告了直立性低血压的患病率、相关因素和结局。
老年患者中直立性低血压的患病率在13%至30.3%之间。高血压是最一致相关的诊断。三项研究中有两项未发现直立性低血压与死亡率之间存在关联，第三项研究仅在糖尿病和高血压患者中发现了这种关联。
现有信息不支持在基层医疗就诊的患者中进行体位性血压检测作为一种筛查手段。然而，有证据支持对高危亚组患者进行检测。对所提出研究问题的回答将阐明如何在基层医疗中最有效地应用直立性低血压检测。
