Hypertension and Cardiovascular Rehabilitation Unit, Department of Cardiovascular Diseases, Faculty of Medicine, KU Leuven University, Leuven, Belgium.
Hypertension. 2010 Jul;56(1):56-61. doi: 10.1161/HYPERTENSIONAHA.110.151654. Epub 2010 May 10.
Aims of the study were to assess in an elderly population the prevalences of orthostatic hypotension at different times after standing and of nighttime reverse dipping on ambulatory blood pressure monitoring, as well as their interrelationships and relative prognostic power for incident cardiovascular events. The study population consisted of 374 patients (225 women), aged 70.2+/-8.5 years, registered in 1 primary care practice and without major cardiovascular events or other comorbidities at baseline. They experienced 76 first cardiovascular events (death, myocardial infarction, or stroke) during 3406 years of follow-up. Systolic/diastolic orthostatic hypotension, defined as a decrease of systolic/diastolic blood pressure of >or=20/>or=10 mm Hg, was present in 24.0%/13.3% of the patients immediately after standing, and in, respectively, 18.1%/10.5% and 12.4%/11.6% after 1 and 2 minutes, whereas systolic/diastolic reverse dipping occurred in 14.4%/9.5%. Orthostatic hypotension was 2 to 3 times more prevalent in reverse dippers than in dippers (P<or=0.01). Systolic orthostatic hypotension was a significant and independent predictor of cardiovascular events, which was stronger during recovery than immediately after standing; in Cox regression analysis, the adjusted hazard ratio amounted to 2.38 (P<0.01) after 2 minutes. The independent predictive power of diastolic orthostatic hypotension was only significant soon after standing (P<0.05). Systolic and diastolic reverse dipping carried prognostic significance in univariable analyses (P<0.001) but not after adjustment for confounders, including 24-hour blood pressure. We conclude that orthostatic hypotension contributes to the phenomenon of reverse dipping but is a more robust predictor of cardiovascular events than reverse dipping in the elderly of the current study.
评估老年人在不同时间站立后体位性低血压和夜间反向血压下降的发生率，以及它们在动态血压监测中的相互关系和对心血管事件的相对预测价值。研究人群包括 374 名年龄 70.2+/-8.5 岁的患者（225 名女性），来自 1 个基层医疗机构，基线时无重大心血管事件或其他合并症。在 3406 年的随访中，他们经历了 76 例首发心血管事件（死亡、心肌梗死或中风）。体位性低血压定义为收缩压/舒张压下降>20/>10mmHg，24.0%/13.3%的患者立即站立后存在，分别为 18.1%/10.5%和 12.4%/11.6%在 1 分钟和 2 分钟后，而收缩压/舒张压反向下降发生在 14.4%/9.5%。反向下降者体位性低血压的发生率是下降者的 2 至 3 倍（P<0.01）。收缩性体位性低血压是心血管事件的显著且独立的预测因子，在恢复期间比立即站立时更强；在 Cox 回归分析中，调整后的危险比在 2 分钟后达到 2.38（P<0.01）。舒张压体位性低血压的独立预测能力仅在立即站立时具有显著意义（P<0.05）。收缩性和舒张压反向下降在单变量分析中具有预后意义（P<0.001），但在调整混杂因素后，包括 24 小时血压，无显著意义。我们得出结论，体位性低血压有助于反向下降现象，但在本研究的老年人中，它是心血管事件的更可靠预测因子，而不是反向下降。
