Townsend Raymond R, Chang Tara I, Cohen Debbie L, Cushman William C, Evans Gregory W, Glasser Stephen P, Haley William E, Olney Christine, Oparil Suzanne, Del Pinto Rita, Pisoni Roberto, Taylor Addison A, Umanath Kausik, Wright Jackson T, Yeboah Joseph
Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.
J Am Soc Hypertens. 2016 Nov;10(11):847-856. doi: 10.1016/j.jash.2016.08.005. Epub 2016 Aug 26.
Orthostatic changes in systolic blood pressure (SBP) impact cardiovascular outcomes. In this study, we aimed to determine the pattern of orthostatic systolic pressure changes in participants enrolled in the SBP Intervention Trial (SPRINT) at their baseline visit before randomization and sought to understand clinical factors predictive of these changes. Of the 9323 participants enrolled in SPRINT, 8662 had complete data for these analyses. The SBP after 1 minute of standing was subtracted from the mean value of the three preceding seated SBP values. At the baseline visit, medical history, medications, anthropometric measures, and standard laboratory testing were undertaken. The mean age of SPRINT participants was 68 years, two-thirds were male, with 30% black, 11% Hispanic, and 55% Caucasian. The spectrum of SBP changes on standing demonstrated that increases in SBP were as common as declines, and about 5% of participants had an increase, and 5% had a decrease of >20 mm Hg in SBP upon standing. Female sex, taller height, more advanced kidney disease, current smoking, and several drug classes were associated with larger declines in BP upon standing, while black race, higher blood levels of glucose and sodium, and heavier weight were associated with more positive values of the change in BP upon standing. Our cross-sectional results show a significant spectrum of orthostatic SBP changes, reflecting known (eg, age) and less well-known (eg, kidney function) relationships that may be important considerations in determining the optimal target blood pressure in long-term outcomes of older hypertensive patients.
收缩压（SBP）的直立位变化会影响心血管结局。在本研究中，我们旨在确定收缩压干预试验（SPRINT）参与者在随机分组前基线访视时的直立位收缩压变化模式，并试图了解可预测这些变化的临床因素。在SPRINT纳入的9323名参与者中，8662名有完整数据用于这些分析。用站立1分钟后的收缩压减去前三个坐位收缩压值的平均值。在基线访视时，记录病史、用药情况、人体测量指标和标准实验室检查结果。SPRINT参与者的平均年龄为68岁，三分之二为男性，其中30%为黑人，11%为西班牙裔，55%为白人。站立时收缩压变化的范围表明，收缩压升高与下降的情况同样常见，约5%的参与者站立时收缩压升高，5%的参与者站立时收缩压下降>20 mmHg。女性、身高较高、肾病更严重、当前吸烟以及几类药物与站立时血压下降幅度较大有关，而黑人种族、血糖和血钠水平较高以及体重较重与站立时血压变化的正值更大有关。我们的横断面研究结果显示，直立位收缩压变化范围显著，反映了已知（如年龄）和不太知名（如肾功能）的关系，这些关系可能是确定老年高血压患者长期预后最佳血压目标时的重要考虑因素。
