Tell G S, Prineas R J, Gomez-Marin O
Center for Prevention Research and Biometry, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, NC 27103.
Am J Epidemiol. 1988 Aug;128(2):360-9. doi: 10.1093/oxfordjournals.aje.a114976.
Because studies have suggested a possible relation between vascular responsiveness to postural changes and risk of subsequent myocardial infarction, the reactivity of blood pressure and pulse rate to change from supine to standing positions was examined in 158 black males, 144 black females, 342 white males, and 272 white females aged 14-16 years. The study was part of the Minneapolis Children's Blood Pressure Study and was conducted during October to December 1985. Two blood pressure readings and one pulse reading were taken after five minutes of supine rest, immediately upon standing, and five minutes after standing. After adjustment for body mass index, mean systolic blood pressure decreased, and fourth- and fifth-phase diastolic blood pressures and pulse rate increased from supine to standing positions in all race and sex groups. Black males had significantly larger changes in systolic pressure than did white males (-5.9 vs. -4.1 mmHg), and males had significantly larger changes in fourth- and fifth-phase diastolic pressures compared with females of the same race (fourth-phase diastolic pressure, 8.0 vs. 4.1 mmHg for blacks and 10.0 vs. 4.8 mmHg for whites). Fifth-phase diastolic pressure increased more than did fourth-phase diastolic pressure in all groups. No race or sex differences were seen for pulse changes. For all race-sex groups, decreases in systolic pressure were positively correlated with initial levels of supine systolic pressure, whereas increases in fourth- and fifth-phase diastolic pressures were negatively correlated with corresponding initial levels. Measurement of postural changes may provide a clinically simple and reproducible way of testing for abnormalities in blood pressure and may better discriminate those at high risk of hypertension and its cardiovascular complications than would the commonly used single-seated blood pressure measurement.
由于研究表明血管对体位变化的反应性与后续心肌梗死风险之间可能存在关联，因此对158名14至16岁的黑人男性、144名黑人女性、342名白人男性和272名白人女性进行了血压和脉搏率对从仰卧位到站立位变化的反应性检查。该研究是明尼阿波利斯儿童血压研究的一部分，于1985年10月至12月进行。在仰卧休息五分钟后、站立后立即以及站立五分钟后分别测量两次血压读数和一次脉搏读数。在调整体重指数后，所有种族和性别的组中，平均收缩压从仰卧位到站立位均下降，第四和第五阶段舒张压以及脉搏率均升高。黑人男性的收缩压变化明显大于白人男性（-5.9 vs. -4.1 mmHg），并且男性在第四和第五阶段舒张压的变化明显大于同种族女性（黑人第四阶段舒张压，8.0 vs. 4.1 mmHg；白人10.0 vs. 4.8 mmHg）。所有组中第五阶段舒张压的升高均大于第四阶段舒张压。在脉搏变化方面未观察到种族或性别差异。对于所有种族-性别组，收缩压的下降与仰卧位收缩压的初始水平呈正相关，而第四和第五阶段舒张压的升高与相应的初始水平呈负相关。体位变化的测量可能为检测血压异常提供一种临床上简单且可重复的方法，并且与常用的单坐位血压测量相比，可能能更好地区分高血压及其心血管并发症的高风险人群。
