Center for Emergency Medicine, Skåne University Hospital, Entrance 35, Floor 2, 205 02, Malmö, Sweden.
Eur J Epidemiol. 2011 Jul;26(7):537-46. doi: 10.1007/s10654-011-9578-1. Epub 2011 Apr 13.
Orthostatic hypotension (OH) is associated with increased total mortality but contribution of specific death causes has not been thoroughly explored. In this prospective study, authors followed up 32,068 individuals without baseline history of cancer or cardiovascular disease (69% men; mean age, 46 years; range, 26-61 years) over a period of 24 years. Hazard ratios (HRs) for total and cause-specific mortality associated with presence of OH and by quartiles of postural systolic blood pressure response (∆SBP) were assessed using multivariate adjusted Cox regression model. A total of 7,145 deaths (22.3%, 9.4 deaths/1,000 person-years) occurred during follow-up. Those with OH (n = 1,943) had higher risk of death due to injury (HR, 1.88; 1.37-2.57) and neurological disease (HR, 2.21; 1.39-3.51). Analogically, risk of death caused by injury and neurological disease increased across the quartiles of ∆SBP from hyper- (Q1(SBP), +8.5 ± 4.7 mmHg) to hypotensive response (Q4(SBP), -13.7 ± 5.7 mmHg; HR, 1.32; 1.00-1.72, and 1.84; 1.20-2.82, respectively) as did also risk of death due to respiratory disease (Q4(SBP) vs. Q1(SBP): HR, 1.53; 1.14-2.04). In contrast, risk curve for cerebrovascular death was U-shaped with nadir in the mildly hypotensive 3rd quartile of ∆SBP (-5.0 ± 0.1 mmHg, Q3(SBP) vs. Q1(SBP): HR, 0.75; 0.54-1.03; P for linear trend = 0.021). Additionally, cardiovascular mortality was increased among 5,805 rescreened participants (mean age, 53 years; 9.8% OH positive: HR, 1.54; 1.24-1.89, and Q4(SBP) vs. Q1(SBP): 1.27; 1.02-1.57, respectively). In summary, increased mortality predicted by blood pressure fall on standing is associated with injuries, neurodegenerative, and respiratory diseases, as well as with cardiovascular disease in older adults. Moreover, both increase and pronounced decrease of SBP during early orthostasis indicate higher risk of cerebrovascular death.
直立性低血压（OH）与总死亡率增加有关，但特定死亡原因的贡献尚未得到充分探讨。在这项前瞻性研究中，作者对 32068 名无基线癌症或心血管疾病史的个体（69%为男性；平均年龄 46 岁；范围 26-61 岁）进行了 24 年的随访。使用多变量调整 Cox 回归模型评估 OH 存在与体位收缩压反应（∆SBP）四分位数相关的总死亡率和特定原因死亡率的风险比（HR）。在随访期间共发生 7145 例死亡（22.3%，每 1000 人年 9.4 例死亡）。患有 OH（n=1943）的个体因伤害（HR，1.88；1.37-2.57）和神经疾病（HR，2.21；1.39-3.51）而死亡的风险更高。类似地，随着∆SBP 从超（Q1（SBP），+8.5±4.7mmHg）到低血压反应（Q4（SBP），-13.7±5.7mmHg；HR，1.32；1.00-1.72，和 1.84；1.20-2.82），伤害和神经疾病导致的死亡风险以及呼吸疾病导致的死亡风险也随之增加（Q4（SBP）比 Q1（SBP）：HR，1.53；1.14-2.04）。相比之下，脑血管死亡的风险曲线呈 U 型，在∆SBP 的轻度低血压第 3 四分位数（Q3（SBP），-5.0±0.1mmHg）处出现最低点，与 Q1（SBP）相比：HR，0.75；0.54-1.03；P 趋势=0.021）。此外，在重新筛查的 5805 名参与者中，心血管死亡率增加（平均年龄 53 岁；5.8%的 OH 阳性：HR，1.54；1.24-1.89，Q4（SBP）比 Q1（SBP）：1.27；1.02-1.57）。总之，站立时血压下降预测的死亡率增加与伤害、神经退行性和呼吸系统疾病以及老年人的心血管疾病有关。此外，在早期直立期间 SBP 的增加和明显下降都表明脑血管死亡的风险更高。
