The Irish Longitudinal Study of Ageing (TILDA), Lincoln Gate, Trinity College Dublin, Dublin 2, Republic of Ireland.
BMC Geriatr. 2013 Jul 15;13:73. doi: 10.1186/1471-2318-13-73.
Our previously proposed morphological classification of orthostatic hypotension (MOH) is an approach to the definition of three typical orthostatic hemodynamic patterns using non-invasive beat-to-beat monitoring. In particular, the MOH pattern of large drop/non-recovery (MOH-3) resembles the syndrome of supine hypertension-orthostatic hypotension (SH-OH), which is a treatment challenge for clinicians. The aim of this study was to characterise MOH-3 in the first wave of The Irish Longitudinal Study of Ageing (TILDA), with particular attention to concurrent symptoms of orthostatic intolerance (OI), prescribed medications and association with history of faints and blackouts.
The study included all TILDA wave 1 participants who had a Finometer® active stand. Automatic data signal checks were carried out to ensure that active stand data were of sufficient quality. Characterisation variables included demographics, cardiovascular and neurological medications (WHO-ATC), and self-reported information on comorbidities and disability. Multivariable statistics consisted of logistic regression models.
Of the 4,467 cases, 1,456 (33%) were assigned to MOH-1 (small drop, overshoot), 2,230 (50%) to MOH-2 (medium drop, slower but full recovery), and 781 (18%) to MOH-3 (large drop, non-recovery). In the logistic regression model to predict MOH-3, statistically significant factors included being on antidepressants (OR = 1.99, 95% CI: 1.50 - 2.64, P < 0.001) and beta blockers (OR = 1.60, 95% CI: 1.26 - 2.04, P < 0.001). MOH-3 was an independent predictor of OI after full adjustment (OR = 1.47, 95% CI: 1.25 - 1.73, P < 0.001), together with being on hypnotics or sedatives (OR = 1.83, 95% CI: 1.31 - 2.54, P < 0.001). In addition, OI was an independent predictor of history of falls/blackouts after full adjustment (OR = 1.27, 95% CI: 1.09 - 1.48, P = 0.003).
Antidepressants and beta blockers were independently associated with MOH-3, and should be used judiciously in older patients with SH-OH. Hypnotics and sedatives may add to the OI effect of MOH-3. Several trials have demonstrated the benefits of treating older hypertensive patients with cardiovascular medications that were not associated with adverse outcomes in our study. Therefore, the evidence of benefit does not necessarily have to conflict with the evidence of potential harm.
我们之前提出的直立性低血压形态学分类（MOH）是一种使用非侵入性逐搏监测定义三种典型直立性血液动力学模式的方法。特别是，MOH 大降幅/无恢复模式（MOH-3）类似于仰卧位高血压-直立性低血压综合征（SH-OH），这对临床医生来说是一个治疗挑战。本研究的目的是在爱尔兰老龄化纵向研究（TILDA）的第一波中描述 MOH-3，特别关注直立不耐受（OI）的并发症状、处方药物以及与晕厥和昏厥史的关系。
本研究包括所有接受 Finometer®主动站立测试的 TILDA 波 1 参与者。进行自动数据信号检查以确保主动站立数据具有足够的质量。特征变量包括人口统计学、心血管和神经系统药物（WHO-ATC）以及与共病和残疾相关的自我报告信息。多变量统计包括逻辑回归模型。
在 4467 例病例中，1456 例（33%）被分配到 MOH-1（小降幅，过冲），2230 例（50%）到 MOH-2（中降幅，较慢但完全恢复），781 例（18%）到 MOH-3（大降幅，无恢复）。在预测 MOH-3 的逻辑回归模型中，统计学上显著的因素包括服用抗抑郁药（OR=1.99，95%CI：1.50-2.64，P<0.001）和β受体阻滞剂（OR=1.60，95%CI：1.26-2.04，P<0.001）。MOH-3 是完全调整后的 OI 的独立预测因子（OR=1.47，95%CI：1.25-1.73，P<0.001），与服用催眠药或镇静剂（OR=1.83，95%CI：1.31-2.54，P<0.001）有关。此外，OI 是完全调整后晕厥/昏厥史的独立预测因子（OR=1.27，95%CI：1.09-1.48，P=0.003）。
抗抑郁药和β受体阻滞剂与 MOH-3 独立相关，在伴有 SH-OH 的老年患者中应谨慎使用。催眠药和镇静剂可能会增加 MOH-3 的 OI 效应。几项试验已经证明，使用不会导致心血管药物发生不良后果的药物治疗老年高血压患者是有益的，在我们的研究中也是如此。因此，获益的证据不一定与潜在危害的证据相冲突。
