Gilani Artaza, Ramsay Sheena E, Welsh Paul, Papacosta Olia, Lennon Lucy T, Whincup Peter H, Wannamethee S Goya
Research Department of Primary Care and Population Health, University College London, Royal Free Campus, London NW3 2PF, UK.
Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK.
Age Ageing. 2021 Jan 8;50(1):198-204. doi: 10.1093/ageing/afaa146.
orthostatic hypotension (OH) that occurs within, or at, 1 minute of standing is associated with higher risk of falls, myocardial infarction, syncope and mortality, compared to OH that occurs after 1 minute of standing. Whether vitamin D deficiency increases the risk of OH is controversial.
this was a cross-sectional analysis of 3,620 older, community-dwelling men. Multinomial, multiple logistic regression models were used to calculate the risk of OH across categories of vitamin D status (deficient [<25 nmol/l], insufficient [≥25-<50 nmol/l] and sufficient [≥50 nmol/l]) and parathyroid hormone quintile.
men with vitamin D deficiency were more likely to have OH that occurred within 1 minute of standing in univariate logistic regression (OR 1.88, 95% CI 1.40-2.53) and multinomial, multiple logistic regression (OR 1.51, 95% CI 1.06-2.15), compared to men with sufficient levels of vitamin D. Vitamin D insufficiency was not associated with the risk of OH. Elevated parathyroid hormone was not associated with risk of OH.
the absence of an association between vitamin D insufficiency and risk of OH and the presence of an association between vitamin D deficiency and risk of OH suggest that there may be a threshold effect; it is only below a particular level of vitamin D that risk of OH is increased. In this cohort, the threshold was <25 nmol/l. Future work should investigate whether treating vitamin D deficiency can improve postural blood pressure or if preventing vitamin D deficiency reduces the incidence of OH.
与站立1分钟后发生的体位性低血压（OH）相比，站立1分钟内发生的OH与跌倒、心肌梗死、晕厥及死亡风险更高相关。维生素D缺乏是否会增加OH风险存在争议。
这是一项对3620名社区居住老年男性的横断面分析。采用多项、多元逻辑回归模型计算不同维生素D状态类别（缺乏[<25 nmol/l]、不足[≥25 - <50 nmol/l]和充足[≥50 nmol/l]）及甲状旁腺激素五分位数下OH的风险。
在单因素逻辑回归（比值比[OR] 1.88，95%置信区间[CI] 1.40 - 2.53）和多项、多元逻辑回归（OR 1.51，95% CI 1.06 - 2.15）中，与维生素D水平充足的男性相比，维生素D缺乏的男性在站立1分钟内发生OH的可能性更大。维生素D不足与OH风险无关。甲状旁腺激素升高与OH风险无关。
维生素D不足与OH风险之间无关联，而维生素D缺乏与OH风险之间存在关联，这表明可能存在阈值效应；只有当维生素D低于特定水平时，OH风险才会增加。在该队列中，阈值为<25 nmol/l。未来的研究应调查治疗维生素D缺乏是否能改善体位性血压，或者预防维生素D缺乏是否能降低OH的发生率。
