Luukinen H, Koski K, Laippala P, Airaksinen K E J
Department of Public Health Science and General Practice, University of Oulu, and Unit of General Practice, Oulu University Hospital, Finland.
J Intern Med. 2004 Apr;255(4):486-93. doi: 10.1111/j.1365-2796.2004.01313.x.
We investigated the prognostic significance of orthostatic hypotension on the risk of myocardial infarction (MI) amongst the elderly.
Prospective population-based study.
Home-dwelling population.
Orthostatic testing was performed between 8 a.m. and 2 p.m., irrespective of having had meals, on 792 persons, representing 82% of all home-dwelling persons aged > or =70 years living in five municipalities around the city of Oulu.
Occurrence of cases of MI were recorded during mean 3.58 (SD 1.09) years follow-up period, from national mortality statistics and local hospital discharge registers.
Ninety cases of MI, of which 40 were fatal after initial hospitalization, occurred during the follow-up period. Orthostatic diastolic blood pressure (BP) drop 1 min after standing up was associated with subsequent MI, but systolic BP reactions had no predictive value. According to the Cox regression model, the strongest predictor of the occurrence of subsequent MI was found in regard to > or =8 mmHg drop in diastolic BP 1 min after standing up; adjusted for history of MI, diabetes mellitus, chest pain, use of calcium antagonist, beta-blocker, nitrate and diuretic medication, hazard ratio of MI being 2.00 (1.11-3.59).
Orthostatic testing offers a novel means to assess the risk of MI amongst elderly persons. Diastolic BP drop immediately after standing up identifies elderly subjects at a high risk of subsequent MI.
我们调查了体位性低血压对老年人心肌梗死（MI）风险的预后意义。
基于人群的前瞻性研究。
居家人群。
在上午8点至下午2点之间进行体位测试，无论是否用餐，对792人进行了测试，这些人占奥卢市周边五个市镇所有年龄≥70岁的居家老人的82%。
在平均3.58（标准差1.09）年的随访期内，从国家死亡率统计数据和当地医院出院登记册中记录MI病例的发生情况。
在随访期间发生了90例MI，其中40例在初次住院后死亡。站立1分钟后的体位性舒张压（BP）下降与随后的MI相关，但收缩压反应没有预测价值。根据Cox回归模型，站立1分钟后舒张压下降≥8 mmHg是随后发生MI的最强预测因素；在调整了MI病史、糖尿病、胸痛、使用钙拮抗剂、β受体阻滞剂、硝酸盐和利尿剂药物后，MI的风险比为2.00（1.11 - 3.59）。
体位测试提供了一种评估老年人MI风险的新方法。站立后立即出现的舒张压下降可识别出随后发生MI风险较高的老年受试者。
