Ricci Fabrizio, Manzoli Lamberto, Sutton Richard, Melander Olle, Flacco Maria E, Gallina Sabina, De Caterina Raffaele, Fedorowski Artur
aInstitute of Cardiology bDepartment of Neuroscience and Imaging cITAB, Institute of Advanced Biomedical Technologies dDepartment of Medical Sciences, University of Ferrara, Ferrara, Italy eNational Heart and Lung Institute, Imperial College, St Mary's Hospital Campus, London, UK fDepartment of Clinical Sciences, Malmö, Faculty of Medicine, Lund University gDepartment of Cardiology, Skåne University Hospital, Malmö, Sweden.
J Hypertens. 2017 Apr;35(4):776-783. doi: 10.1097/HJH.0000000000001215.
OBJECTIVE(S): We explored incidence, predictors, and long-term prognosis of hospital admissions attributed to reflex syncope and orthostatic hypotension.
We analyzed a cohort of 32 628 individuals (68.2% men; age, 45.6 ± 7.4 years) without prevalent cardiovascular disease over a follow-up period of 26.6 ± 7.5 years.
One thousand and fourteen persons (3.1%, 1.2 per 1000 person-years) had at least 1 hospitalization for orthostatic hypotension (n = 462, 1.42%) or syncope (n = 632, 1.94%). Orthostatic hypotension-related hospitalizations were predicted by age [per 1-year increase, hazard ratio 1.14, 95% confidence interval (CI): 1.12-1.16], smoking (hazard ratio 1.35, 95% CI: 1.12-1.64), diabetes (hazard ratio 1.50, 95% CI: 1.00-2.25), baseline orthostatic hypotension (hazard ratio 1.45, 95% CI: 1.05-1.98), in particular, by SBP fall at least 30 mmHg (hazard ratio 3.93, 95% CI: 2.14-7.23), whereas syncope hospitalizations by age (per 1-year increase, hazard ratio 1.09, 95% CI: 1.07-1.11), smoking (hazard ratio 1.27, 95% CI: 1.08-1.49), and hypertension (hazard ratio 1.42, 95% CI: 1.20-1.69). Both syncope-hospitalized and orthostatic hypotension hospitalized patients had higher burden of hospital admissions for other reasons such as cardiovascular, pulmonary, renal disease, or diabetes. During the follow-up, 10 727 (32.9%) died, with 419 deaths preceded by syncope/orthostatic hypotension hospitalization. After adjustment for traditional risk factors, syncope-hospitalization predicted all-cause mortality (hazard ratio 1.16, 95% CI: 1.02-1.31), whereas orthostatic hypotension hospitalization predicted cardiovascular mortality (hazard ratio 1.13, 95% CI: 1.07-1.19).
Hospital admissions due to syncope and orthostatic hypotension occur in ≈3% of older individuals and increase with age and comorbidities. Admissions due to syncope are associated with prevalent hypertension, whereas those due to orthostatic hypotension overlap with diabetes and previously identified orthostatic hypotension. Syncope-related admissions predict higher all-cause mortality, whereas orthostatic hypotension-related admissions herald increased cardiovascular mortality.
我们探讨了因反射性晕厥和体位性低血压导致的住院发生率、预测因素及长期预后。
我们分析了一组32628名个体（男性占68.2%；年龄45.6±7.4岁），这些个体在26.6±7.5年的随访期内无心血管疾病史。
1014人（3.1%，每1000人年1.2例）至少因体位性低血压（n = 462，1.42%）或晕厥（n = 632，1.94%）住院1次。体位性低血压相关住院的预测因素为年龄（每增加1岁，风险比1.14，95%置信区间[CI]：1.12 - 1.16）、吸烟（风险比1.35，95% CI：1.12 - 1.64）、糖尿病（风险比1.50，95% CI：1.00 - 2.25）、基线体位性低血压（风险比1.45，95% CI：1.05 - 1.98），尤其是收缩压下降至少30 mmHg（风险比3.93，95% CI：2.14 - 7.23）；而晕厥住院的预测因素为年龄（每增加1岁，风险比1.09，95% CI：1.07 - 1.11）、吸烟（风险比1.27，95% CI：1.08 - 1.49）和高血压（风险比1.42，95% CI：1.20 - 1.69）。晕厥住院患者和体位性低血压住院患者因心血管、肺部、肾脏疾病或糖尿病等其他原因导致的住院负担均较高。随访期间，10727人（32.9%）死亡，其中419例死亡前有晕厥/体位性低血压住院史。在调整传统危险因素后，晕厥住院可预测全因死亡率（风险比1.16，95% CI：1.02 - 1.31），而体位性低血压住院可预测心血管死亡率（风险比1.13，95% CI：1.07 - 1.19）。
约3%的老年人因晕厥和体位性低血压住院，且随年龄和合并症增加而增多。因晕厥住院与高血压患病率相关，而因体位性低血压住院与糖尿病及先前确诊的体位性低血压重叠。与晕厥相关的住院预示着较高的全因死亡率，而与体位性低血压相关的住院预示着心血管死亡率增加。
