Press Yan, Punchik Boris, Freud Tamar
aDepartment of Family Medicine, Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the NegevbYasski Clinic, Comprehensive Geriatric Assessment Unit, Clalit Health ServicescUnit for Community Geriatrics, Division of Health in the Community, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
J Hypertens. 2016 Feb;34(2):351-8. doi: 10.1097/HJH.0000000000000781.
To assess the rate of orthostatic hypotension and factors associated with it among elderly patients who underwent a comprehensive, ambulatory geriatric assessment.
The study included patients 65 years and older who were assessed in the outpatient comprehensive geriatric assessment unit. Data were collected from the computerized medical record including sociodemographic data, lifestyle, falls, blood pressure, BMI, functional and cognitive status, medications, and comorbidity.
The study population consisted of 571 patients who underwent assessment over a nine-year period. The mean age was 83.7 ± 6.1, 35.9% were men, and 183 (32.1%) were diagnosed with orthostatic hypotension. Multiple drugs, in general, and multiple drugs with the potential to cause orthostatic hypotension in particular increased the risk for orthostatic hypotension after adjustment for age, sex, chronic comorbidity, and supine systolic blood pressure ≥150 mmHg [odds ratio (OR) = 1.09, 95% confidence interval (CI): 1.03-1.14 and OR = 1.22, 95% CI: 1.08-1.37, respectively]. In addition, α-blockers and calcium channel blockers increased the risk for orthostatic hypotension after similar adjustments (OR = 1.82, 95% CI: 1.01-3.16 and OR = 1.66, 95% CI: 1.11-2.48, respectively). Similarly, two additional drug types increased the risk for orthostatic hypotension: selective serotonin reuptake inhibitors (OR = 2.09, 95% CI: 1.33-3.19) and tricyclic antidepressants (OR = 4.36, 95% CI: 1.85-10.06). There were no specific associations between age, cognitive and functional state, morbidity (as measured by the Charlson Comorbidity Index), and specific diseases, and orthostatic hypotension.
The results of the present study reinforce evidence of an association between drug therapy and orthostatic hypotension.
评估在接受全面门诊老年医学评估的老年患者中体位性低血压的发生率及其相关因素。
该研究纳入了在门诊综合老年医学评估单元接受评估的65岁及以上患者。从计算机化病历中收集数据，包括社会人口统计学数据、生活方式、跌倒情况、血压、体重指数、功能和认知状态、用药情况以及合并症。
研究人群包括在九年期间接受评估的571例患者。平均年龄为83.7±6.1岁，男性占35.9%，183例（32.1%）被诊断为体位性低血压。在对年龄、性别、慢性合并症和仰卧位收缩压≥150 mmHg进行调整后，一般多种药物，尤其是有导致体位性低血压可能性的多种药物会增加体位性低血压的风险[比值比（OR）=1.09，95%置信区间（CI）：1.03 - 1.14；OR = 1.22，95% CI：1.08 - 1.37]。此外，在进行类似调整后，α受体阻滞剂和钙通道阻滞剂也增加了体位性低血压的风险（OR分别为1.82，95% CI：1.01 - 3.16；OR = 1.66，95% CI：1.11 - 2.48）。同样，另外两种药物类型也增加了体位性低血压的风险：选择性5-羟色胺再摄取抑制剂（OR = 2.09，95% CI：1.33 - 3.19）和三环类抗抑郁药（OR = 4.36，95% CI：1.85 - 10.06）。年龄、认知和功能状态、发病率（用查尔森合并症指数衡量）以及特定疾病与体位性低血压之间没有特定关联。
本研究结果进一步证实了药物治疗与体位性低血压之间存在关联的证据。
