维生素 D 缺乏与高龄女性的直立性低血压有关。

Vitamin D deficiency is associated with orthostatic hypotension in oldest-old women.

机构信息

Department of Geriatric Medicine, Angers University Hospital, Angers, France; UPRES EA4638, University of Angers, UNAM, Angers, France; Robarts Research Institute, The University of Western Ontario, London, ON, Canada.

出版信息

J Intern Med. 2014 Sep;276(3):285-95. doi: 10.1111/joim.12201. Epub 2014 Apr 22.

DOI:10.1111/joim.12201

PMID:24444004

Abstract

OBJECTIVES

Orthostatic hypotension, a condition that mostly affects 'oldest-old' (i.e. ≥80 years) adults, is primarily explained by age-related dysfunction of blood pressure control. Vitamin D may contribute to blood pressure control. The aim of this study was to determine whether vitamin D deficiency is associated with orthostatic hypotension in oldest-old adults.

DESIGN

Cross-sectional analysis at baseline of the EPIDOS study.

SETTING

Five French areas.

PARTICIPANTS

A total of 329 community-dwelling oldest-old women (mean age 83.3 ± 0.2 years).

MAIN OUTCOMES MEASURES

Orthostatic hypotension was defined as a systolic blood pressure drop of ≥20 mmHg and/or a diastolic blood pressure drop of ≥10 mmHg within 3 min of standing. Vitamin D deficiency was defined as a serum 25-hydroxyvitamin D (25OHD) concentration ≤10 ng mL(-1) . Covariates included in the models were age, body mass index, diabetes mellitus, supine mean arterial pressure, number of drugs taken per day, use of antihypertensive or psychoactive drugs, cognition, quadriceps strength, current smoking, alcohol consumption, serum concentrations of parathyroid hormone, calcium and creatinine and season of testing.

RESULTS

Diastolic orthostatic hypotension was observed more often among women with vitamin D deficiency (19.2%) compared to those without (10.0%; P = 0.03). There was an inverse linear association between 25OHD concentration and change in diastolic blood pressure after 3 min of standing (adjusted β = -0.07, P = 0.046). Similarly, 25OHD deficiency was associated with orthostatic hypotension [adjusted odds ratio (OR) 3.36, P = 0.004], specifically with diastolic orthostatic hypotension (adjusted OR 3.81, P = 0.003).

CONCLUSIONS

25OHD deficiency was associated with orthostatic hypotension in oldest-old women, due to a greater drop in diastolic blood pressure on standing. This finding may lead to better understanding of the pathophysiology of falls in oldest-old adults with vitamin D deficiency.

摘要

目的

体位性低血压主要影响“最年长的老年人”（即≥80 岁），其主要原因是与年龄相关的血压控制功能障碍。维生素 D 可能有助于血压控制。本研究旨在确定维生素 D 缺乏是否与最年长老年人的体位性低血压有关。

设计

EPIDOS 研究的基线横断面分析。

地点

法国的五个地区。

参与者

共纳入 329 名社区居住的最年长女性（平均年龄 83.3±0.2 岁）。

主要观察指标

体位性低血压定义为站立 3 分钟内收缩压下降≥20mmHg 和/或舒张压下降≥10mmHg。维生素 D 缺乏定义为血清 25-羟维生素 D（25OHD）浓度≤10ng/ml。纳入模型的协变量包括年龄、体重指数、糖尿病、仰卧位平均动脉压、每日服用药物的数量、使用抗高血压或精神药物、认知、股四头肌力量、当前吸烟、饮酒、甲状旁腺激素、钙和肌酐的血清浓度以及测试季节。

结果

与无维生素 D 缺乏的女性（10.0%）相比，维生素 D 缺乏的女性（19.2%）更易出现舒张压体位性低血压（P=0.03）。25OHD 浓度与站立 3 分钟后舒张压变化呈负线性关系（调整后β=-0.07，P=0.046）。同样，25OHD 缺乏与体位性低血压相关[调整后比值比（OR）3.36，P=0.004]，特别是与舒张压体位性低血压相关（调整后 OR 3.81，P=0.003）。