Fedorowski Artur, Burri Philippe, Melander Olle
Department of Medicine, Malmö University Hospital, Malmö, Sweden.
J Hypertens. 2009 May;27(5):976-82. doi: 10.1097/hjh.0b013e3283279860.
Prevalence and determinants of orthostatic hypotension remain largely unexplored in younger individuals without significant burden of chronic diseases.
We investigated frequency and main associations of impaired orthostatic response in a cohort of 469 middle-aged hypertensive patients and 453 of their normotensive first-degree relatives.
13.4% of hypertensive and 5.5% of normotensive study participants were found to have orthostatic hypotension. In a backward logistic regression the following determinants of orthostatic hypotension were identified: sex [female, odds ratio (OR) 2.45, 95% confidence interval (CI) 1.14-5.25, P=0.022], reduced glomerular filtration rate [OR (per ml/min/1.73 m2) 0.97, 95% CI 0.94-0.99, P=0.002], systolic [OR (per mmHg) 1.02, 95% CI 1.00-1.05, P=0.047] and diastolic blood pressure [OR (per mmHg) 1.04, 95% CI 1.00-1.09, P=0.033], and antihypertensive treatment (OR 0.41, 95% CI 0.18-0.93, P=0.034). In hypertensive patients use of angiotensin-converting enzyme inhibitors was related to lower orthostatic hypotension frequency. Percentage of orthostatic hypotension-positive patients in the highest blood pressure stratum (> or = 160 mmHg) decreased from 20.2 to 7.6, when diagnostic criteria of orthostatic hypotension were adjusted for mean systolic orthostatic reaction (2 SD value: 30 mmHg) . During follow-up (t=6.6 years) individuals with impaired orthostatic response showed a trend towards increased total mortality (OR 2.16, 95% CI 0.97-4.80, P=0.06) in a crude model.
Prevalence of orthostatic hypotension in hypertensive patients is higher than in their normotensive first-degree relatives. Independently of age, sex, and elevated blood pressure, orthostatic hypotension may be additionally determined by impaired renal function. Antihypertensive treatment seems to protect from orthostatic hypotension, in particular, use of angiotensin-converting enzyme inhibitors in hypertensive patients. The diagnostic criteria of orthostatic hypotension may need adjustment for initial supine systolic blood pressure to increase clinical accuracy. The prognostic value of impaired orthostatic response regarding risk of cardiovascular disease and mortality remains uncertain and requires further studies.
在没有重大慢性病负担的年轻个体中，体位性低血压的患病率和决定因素在很大程度上仍未得到充分研究。
我们调查了469名中年高血压患者及其453名血压正常的一级亲属队列中体位性反应受损的频率和主要关联因素。
发现13.4%的高血压研究参与者和5.5%的血压正常研究参与者患有体位性低血压。在向后逻辑回归分析中，确定了以下体位性低血压的决定因素：性别[女性，比值比（OR）2.45，95%置信区间（CI）1.14 - 5.25，P = 0.022]、肾小球滤过率降低[OR（每ml/min/1.73 m²）0.97，95% CI 0.94 - 0.99，P = 0.002]、收缩压[OR（每mmHg）1.02，95% CI 1.00 - 1.05，P = 0.047]和舒张压[OR（每mmHg）1.04，95% CI 1.00 - 1.09，P = 0.033]，以及抗高血压治疗（OR 0.41，95% CI 0.18 - 0.93，P = 0.034）。在高血压患者中，使用血管紧张素转换酶抑制剂与较低的体位性低血压频率相关。当根据平均收缩期体位反应（2个标准差：30 mmHg）调整体位性低血压的诊断标准时，最高血压分层（≥160 mmHg）中体位性低血压阳性患者的百分比从20.2%降至7.6%。在随访期间（t = 6.6年），在一个粗略模型中，体位性反应受损的个体显示出总死亡率增加的趋势（OR 2.16，95% CI 0.97 - 4.80，P = 0.06）。
高血压患者中体位性低血压的患病率高于其血压正常的一级亲属。独立于年龄（此处原文有误，前文未提及年龄是独立因素，推测应是独立于年龄、性别和血压升高）、性别和血压升高之外，体位性低血压可能还由肾功能受损所决定。抗高血压治疗似乎可预防体位性低血压，特别是高血压患者使用血管紧张素转换酶抑制剂。体位性低血压的诊断标准可能需要根据初始仰卧位收缩压进行调整，以提高临床准确性。体位性反应受损对心血管疾病风险和死亡率的预后价值仍不确定，需要进一步研究。
