Rutan G H, Hermanson B, Bild D E, Kittner S J, LaBaw F, Tell G S
Department of Veterans Affairs, Memphis, Tenn.
Hypertension. 1992 Jun;19(6 Pt 1):508-19. doi: 10.1161/01.hyp.19.6.508.
The purpose of the present study was to assess the prevalence of orthostatic hypotension and its associations with demographic characteristics, cardiovascular risk factors and symptomatology, prevalent cardiovascular disease, and selected clinical measurements in the Cardiovascular Health Study, a multicenter, observational, longitudinal study enrolling 5,201 men and women aged 65 years and older at initial examination. Blood pressure measurements were obtained with the subjects in a supine position and after they had been standing for 3 minutes. The prevalence of asymptomatic orthostatic hypotension, defined as 20 mm Hg or greater decrease in systolic or 10 mm Hg or greater decrease in diastolic blood pressure, was 16.2%. This prevalence increased to 18.2% when the definition also included those in whom the procedure was aborted due to dizziness upon standing. The prevalence was higher at successive ages. Orthostatic hypotension was associated significantly with difficulty walking (odds ratio, 1.23; 95% confidence interval, 1.02, 1.46), frequent falls (odds ratio, 1.52; confidence interval, 1.04, 2.22), and histories of myocardial infarction (odds ratio, 1.24; confidence interval, 1.02, 1.50) and transient ischemic attacks (odds ratio, 1.68; confidence interval, 1.12, 2.51). History of stroke, angina pectoris, and diabetes mellitus were not associated significantly with orthostatic hypotension. In addition, orthostatic hypotension was associated with isolated systolic hypertension (odds ratio, 1.35; confidence interval, 1.09, 1.68), major electrocardiographic abnormalities (odds ratio, 1.21; confidence interval, 1.03, 1.42), and the presence of carotid artery stenosis based on ultrasonography (odds ratio, 1.67; confidence interval, 1.23, 2.26). Orthostatic hypotension was negatively associated with weight. We conclude that orthostatic hypotension is common in the elderly and increases with advancing age. It is associated with cardiovascular disease, particularly those manifestations measured objectively, such as carotid stenosis. It is associated also with general neurological symptoms, but this link may not be causal. Differences in prevalence of and associations with orthostatic hypotension in the present study compared with others are largely attributed to differences in population characteristics and methodology.
本研究的目的是评估体位性低血压的患病率及其与人口统计学特征、心血管危险因素和症状、心血管疾病患病率以及选定临床测量指标之间的关联。心血管健康研究是一项多中心、观察性、纵向研究，初始检查时纳入了5201名65岁及以上的男性和女性。分别在受试者仰卧位时以及站立3分钟后测量血压。无症状体位性低血压的患病率定义为收缩压下降20mmHg或更多，或舒张压下降10mmHg或更多，为16.2%。当定义还包括那些因站立时头晕而中止检查的人时，这一患病率升至18.2%。患病率随年龄增长而升高。体位性低血压与行走困难（优势比，1.23；95%置信区间，1.02，1.46）、频繁跌倒（优势比，1.52；置信区间，1.04，2.22）、心肌梗死病史（优势比，1.24；置信区间，1.02，1.50）和短暂性脑缺血发作（优势比，1.68；置信区间，1.12，2.51）显著相关。中风、心绞痛和糖尿病病史与体位性低血压无显著关联。此外，体位性低血压与单纯收缩期高血压（优势比，1.35；置信区间，1.09，1.68）、主要心电图异常（优势比，1.21；置信区间，1.03，1.42）以及基于超声检查的颈动脉狭窄的存在（优势比，1.67；置信区间，1.23，2.26）相关。体位性低血压与体重呈负相关。我们得出结论，体位性低血压在老年人中很常见，且随年龄增长而增加。它与心血管疾病相关，尤其是那些客观测量的表现，如颈动脉狭窄。它也与一般神经症状相关，但这种联系可能不是因果关系。本研究中体位性低血压的患病率及其关联与其他研究的差异很大程度上归因于人群特征和方法的差异。
