Center for Emergency Medicine, Malmö University Hospital, Malmö, Sweden.
J Hypertens. 2010 Mar;28(3):551-9. doi: 10.1097/HJH.0b013e3283350e8c.
To investigate the determinants and consequences of orthostatic hypotension in the middle-aged segment of the general population.
A population of 5722 men aged 52.6 +/- 3.6 years, previously included in the Malmö Preventive Project (n = 22 444 men), was re-screened after 5.6 +/- 1.0 years and thereafter followed up over a period of 19.6 +/- 5.3 years.
At re-screening, 566 (9.9%) participants were found to have orthostatic hypotension according to international consensus criteria, of these 365 (64.5%) demonstrated systolic impairment only. In a multivariate adjusted logistic regression model, age, low BMI, hypertension, increased heart rate, antihypertensive treatment, diabetes and current smoking independently determined orthostatic hypotension, but systolic impairment also showed association with higher pulse pressure and reduced glomerular filtration rate. In a multivariate adjusted Cox proportional hazard model, men with orthostatic hypotension demonstrated a higher risk of incident coronary event, stroke and all-cause mortality than men without orthostatic hypotension. Systolic impairment was a better predictor of all studied endpoints than were the combined criteria of orthostatic hypotension. Moreover, participants with orthostatic hypotension at both baseline and re-screening showed the highest risk of any adverse event (hazard risk 1.76, 95% confidence interval 1.28-2.43, P = 0.001), exceeding the risk predicted by orthostatic hypotension at re-screening only (hazard risk 1.22, 95% confidence interval 1.07-1.38, P = 0.003).
Orthostatic hypotension may be found in up to 10% of middle-aged men and correlates with well known cardiovascular risk factors such as hypertension, smoking, diabetes and kidney failure. Orthostatic impairment seems to constitute an independent cardiovascular risk factor and may be practically estimated by systolic reaction only. As orthostatic reaction may vary over time, repeated measurements or more accurate diagnostic methods are recommended to identify high-risk patients with persistent orthostatic hypotension.
研究中年人群体位性低血压的决定因素和后果。
在马尔默预防项目中，先前纳入了 22444 名年龄为 52.6±3.6 岁的男性，在随访 5.6±1.0 年后对其中 5722 名男性进行了重新筛查，并在接下来的 19.6±5.3 年进行了随访。
在重新筛查时，根据国际共识标准，566 名（9.9%）参与者被诊断为体位性低血压，其中 365 名（64.5%）仅表现为收缩压受损。在多变量调整的逻辑回归模型中，年龄、低 BMI、高血压、心率增加、降压治疗、糖尿病和当前吸烟独立决定了体位性低血压，但收缩压受损也与较高的脉压和降低的肾小球滤过率相关。在多变量调整的 Cox 比例风险模型中，患有体位性低血压的男性发生冠心病事件、中风和全因死亡率的风险高于没有体位性低血压的男性。与体位性低血压的综合标准相比，收缩压受损是所有研究终点的更好预测因素。此外，在基线和重新筛查时均患有体位性低血压的参与者发生任何不良事件的风险最高（风险比 1.76，95%置信区间 1.28-2.43，P=0.001），超过了仅在重新筛查时患有体位性低血压预测的风险（风险比 1.22，95%置信区间 1.07-1.38，P=0.003）。
体位性低血压在中年男性中可能高达 10%，与高血压、吸烟、糖尿病和肾功能衰竭等已知的心血管危险因素相关。体位性损害似乎构成了一个独立的心血管危险因素，仅通过收缩压反应就可以进行实际估计。由于体位反应可能随时间而变化，因此建议重复测量或更准确的诊断方法来识别持续存在体位性低血压的高危患者。
