Section for Research, Department of Medicine, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Department of Medicine, Division of Gerontology, Beth Israel Deaconess Medical Center, Marcus Institute for Aging Research, Hebrew Senor Life, & Harvard Medical School, Boston, Massachusetts, USA.
Am J Hypertens. 2019 Jun 11;32(7):684-694. doi: 10.1093/ajh/hpz015.
To determine the effects of orthostatic hypotension (OH) measurement timing on its associations with dizziness, falls, fractures, cardiovascular disease (CVD), and mortality.
We analyzed OH measurements from the Action to Control Cardiovascular Risk in Diabetes BP trial, which evaluated two blood pressure (BP) goals (systolic BP [SBP] < 120 mm Hg vs. SBP < 140 mm Hg) and incident CVD among adults with diabetes and hypertension. Seated BP was measured after 5 minutes of rest at baseline and follow-up visits (12 months, 48 months, and exit). Standing BP was measured 3 consecutive times (M1-M3) after standing, starting at 1 minute with each measurement separated by 1 minute. Consensus OH was defined as a drop in SBP ≥ 20 mm Hg or diastolic BP (DBP) ≥ 10 mm Hg. Participants were asked about orthostatic dizziness, recent falls, and recent fractures, and underwent surveillance for CVD events and all-cause mortality.
There were 4,268 participants with OH assessments over 8,450 visits (mean age 62.6 years [SD = 6.6]; 46.6% female; 22.3% black). Although all measures of consensus OH were significantly associated with dizziness, none were associated with falls, and only M2 (~3 minutes) was significantly associated with fractures. No measurements were associated with CVD events, but later measurements were significantly associated with mortality. BP treatment goal did not increase risk of OH regardless of timing. Associations were not consistently improved by the mean or minimum of M1-M3.
In this population of adults with hypertension and diabetes, neither single time nor set of measurements were clearly superior with regard to outcomes. These findings support the use of a flexibly timed, single measurement to assess OH in clinical practice.
Trial Number NCT00000620.
确定直立性低血压（OH）测量时间对其与头晕、跌倒、骨折、心血管疾病（CVD）和死亡率之间关联的影响。
我们分析了来自“行动控制心血管风险糖尿病血压试验”（Action to Control Cardiovascular Risk in Diabetes BP trial）的 OH 测量结果，该试验评估了两种血压（BP）目标（收缩压 [SBP] < 120mmHg 与 SBP < 140mmHg）以及糖尿病和高血压成年人的 CVD 事件发生率。在基线和随访（12 个月、48 个月和退出）时，静坐血压在休息 5 分钟后测量。站立血压在站立后连续测量 3 次（M1-M3），每次测量之间间隔 1 分钟。共识性 OH 定义为 SBP 下降≥20mmHg 或舒张压（DBP）下降≥10mmHg。参与者被询问关于直立性头晕、近期跌倒和近期骨折的情况，并接受 CVD 事件和全因死亡率的监测。
共有 4268 名参与者在 8450 次就诊时进行了 OH 评估（平均年龄 62.6 岁 [标准差 = 6.6]；46.6%为女性；22.3%为黑人）。尽管所有共识性 OH 测量均与头晕显著相关，但与跌倒无关，只有 M2（约 3 分钟）与骨折显著相关。没有测量与 CVD 事件相关，但较晚的测量与死亡率显著相关。无论时间如何，BP 治疗目标均不会增加 OH 的风险。通过 M1-M3 的平均值或最小值并不能改善关联。
在患有高血压和糖尿病的成年人中，无论是单一时间还是一组测量，在结果方面都没有明显优势。这些发现支持在临床实践中使用灵活时间、单次测量来评估 OH。
试验编号 NCT00000620。
