Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA.
Am J Ther. 2013 May-Jun;20(3):279-91. doi: 10.1097/MJT.0b013e31828bfb7f.
The magnitude of increase in systolic blood pressure in response to the shift from supine to upright posture is considered to reflect the adequacy of orthostatic regulation. Orthostatic integrity is largely maintained by the interaction between the skeletal muscle pump, neurovascular compensation, neurohumoral effects, and cerebral blood flow regulation. Various physiological states and disease conditions may disrupt these mechanisms as seen in vasovagal syncope, dysautonomic orthostatic intolerance, and postural orthostatic tachycardia syndrome. Orthostatic hypotension (OH) and decreased cerebral blood flow are strongly related. Even subclinical OH has been associated to different degrees with impaired cognitive function, decreased effort, reduced motivation, increased hopelessness, and signs of attention-deficit hyperactivity disorder and dementia, diabetes mellitus, and Parkinson disease. Furthermore, subclinical levels of inadequate blood pressure regulation in response to orthostasis have been linked to increased depression and anxiety and intergenerational behavioral sequelae between mother and child. Identifying causes of subclinical and clinical OH is critical in improving quality of life for both children and older adults. A better understanding of the underlying causes responsible for the etiology of OH could lead to a rational design of novel effective therapeutic regimens for the treatment of this condition and associated comorbidities.
从仰卧位转为直立位时，收缩压升高的幅度被认为反映了直立调节的充分性。直立完整性主要通过骨骼肌泵、神经血管代偿、神经体液效应和脑血流调节之间的相互作用来维持。各种生理状态和疾病状况可能会破坏这些机制，如血管迷走性晕厥、自主神经功能障碍性直立不耐受和体位性心动过速综合征。直立性低血压（OH）和脑血流量减少密切相关。即使是亚临床 OH 也与认知功能受损、体力下降、动机降低、绝望感增加以及注意力缺陷多动障碍和痴呆、糖尿病和帕金森病的迹象有关。此外，对直立反应的血压调节不足的亚临床水平与抑郁和焦虑增加以及母婴之间的代际行为后果有关。确定亚临床和临床 OH 的原因对于改善儿童和老年人的生活质量至关重要。更好地了解导致 OH 病因的潜在原因，可能会导致针对这种情况及其相关合并症的新型有效治疗方案的合理设计。
