1 Department of Human Movement Sciences @AgeAmsterdam Amsterdam Movement Sciences Vrije Universiteit Amsterdam Amsterdam the Netherlands.
2 Department of Biophysics Donders Institute for Brain, Cognition and Behaviour Radboud University Nijmegen the Netherlands.
J Am Heart Assoc. 2018 Nov 6;7(21):e010060. doi: 10.1161/JAHA.118.010060.
Background Orthostatic hypotension is a prevalent condition in older adults and is associated with impaired physical performance and falls. The ability of older adults to compensate for rapid changes in systolic blood pressure ( SBP ; ie, SBP decline rate and SBP variability) may be important for physical performance. This study investigates the association of rapid SBP changes after standing up with physical performance. Methods and Results Consecutive patients who visited the Center of Geriatrics Amsterdam in 2014 and 2015 were included. The following SBP parameters were computed in 2 intervals (0-15 and 15-180 seconds) after standing up: steepness of steepest SBP decline; ratio of standing/supine SBP variability; and magnitude of largest SBP decline. Physical performance was assessed using the following measures: chair stand time, timed up and go time, walking speed, handgrip strength, and tandem stance performance. A total of 109 patients (45% men; age, mean, 81.7 years [ standard deviation , 7.0 years]) were included. Steepness of steepest SBP decline (0-15 seconds) was associated with slower chair stand time ( P<0.001), timed up and go time ( P=0.022), and walking speed ( P=0.024). Ratio of standing/supine SBP variability (0-15 seconds) was associated with slower chair stand time ( P=0.005). Magnitude of largest SBP decline was not associated with physical performance. Conclusions SBP parameters reflecting rapid SBP changes were more strongly associated with physical performance compared with SBP decline magnitude in geriatric outpatients. These results support the hypothesis of an inadequate cerebral autoregulation during rapid SBP changes and advocate the use of continuous blood pressure measurements.
直立性低血压是老年人中普遍存在的一种病症，与身体机能下降和跌倒有关。老年人对收缩压（SBP）快速变化进行代偿的能力（即 SBP 下降率和 SBP 变异性）可能对身体机能很重要。本研究旨在探讨站立后 SBP 快速变化与身体机能之间的关系。
连续纳入 2014 年和 2015 年在阿姆斯特丹老年医学中心就诊的患者。在站立后 0-15 秒和 15-180 秒两个时间段内计算以下 SBP 参数：SBP 下降最陡斜率；站立/卧位 SBP 变异性比值；最大 SBP 下降幅度。使用以下指标评估身体机能：椅上站立时间、起立-行走计时测试时间、步行速度、握力和并足站立测试。共纳入 109 例患者（45%为男性；年龄，平均值 81.7 岁[标准差 7.0 岁]）。SBP 下降最陡斜率（0-15 秒）与椅上站立时间较慢（P<0.001）、起立-行走计时测试时间较长（P=0.022）和步行速度较慢（P=0.024）相关。站立/卧位 SBP 变异性比值（0-15 秒）与椅上站立时间较慢相关（P=0.005）。最大 SBP 下降幅度与身体机能无关。
与老年门诊患者 SBP 下降幅度相比，反映 SBP 快速变化的 SBP 参数与身体机能的相关性更强。这些结果支持在 SBP 快速变化期间存在脑自动调节不足的假说，并提倡使用连续血压测量。
