Roosendaal Elizabeth J, Moeskops Simone J, Germans Tjeerd, Ruiter Jaap H, Jansen René W M M
Department of Geriatric Medicine, Northwest Clinics, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands.
Department of Cardiology, Northwest Clinics, Alkmaar, The Netherlands.
Eur Geriatr Med. 2018 Aug;9(4):485-492. doi: 10.1007/s41999-018-0063-1. Epub 2018 May 16.
To evaluate different patterns of orthostatic hypotension (OH) and its relation to mortality in older patients with unexplained falls or syncope.
This is an observational cohort study in consecutive patients aged ≥ 65 years with unexplained falls or syncope at a Fall Syncope day clinic November 2011 until May 2016. OH is defined as a decrease in systolic blood pressure (BP) ≥ 20 mmHg and/or in diastolic BP ≥ 10 mmHg during standing test. Main outcomes are the baseline characteristics and prevalence of patients with classical OH (decrease BP until 3 min), delayed OH (decrease of BP from 5 to 10 min) and continuous OH (decrease of BP for 10 min). Secondary outcome is the relation between different OH patterns and mortality.
Of 374 patients with a mean age of 80 year (SD 6.6), 56% of the patients had OH: 16% had classical OH, 8% delayed OH, 32% had continuous OH and 44% had no OH. Patients with continuous OH and patients with delayed OH tended to have a higher mortality compared to patients with classical OH, 14 vs. 5% (P = 0.07) and 17 vs. 5% (P = 0.06). This possible relation between OH patterns and mortality could not be confirmed in multivariate analysis.
In these very old patients, there are various patterns of decline in standing BP. Delayed and continuous OH will be missed if BP is measured only for 3 min during standing. This is important because patients with continuous OH and delayed OH might have a relation with mortality. Our results encourage additional studies investigating the relation between different OH patterns and mortality.
评估老年不明原因跌倒或晕厥患者体位性低血压（OH）的不同模式及其与死亡率的关系。
这是一项观察性队列研究，研究对象为2011年11月至2016年5月在跌倒与晕厥日间诊所连续就诊的年龄≥65岁的不明原因跌倒或晕厥患者。OH定义为站立试验期间收缩压（BP）下降≥20 mmHg和/或舒张压下降≥10 mmHg。主要结局是经典OH（血压下降持续至3分钟）、延迟OH（血压在5至10分钟下降）和持续性OH（血压下降持续10分钟）患者的基线特征和患病率。次要结局是不同OH模式与死亡率之间的关系。
在374例平均年龄80岁（标准差6.6）的患者中，56%的患者存在OH：16%为经典OH，8%为延迟OH，32%为持续性OH，44%无OH。与经典OH患者相比，持续性OH患者和延迟OH患者的死亡率往往更高，分别为14%对5%（P = 0.07）和17%对5%（P = 0.06）。多因素分析未能证实OH模式与死亡率之间的这种可能关系。
在这些高龄患者中，站立时血压下降有多种模式。如果站立时仅测量3分钟血压，延迟性和持续性OH将被漏诊。这很重要，因为持续性OH和延迟OH患者可能与死亡率有关。我们的结果鼓励开展更多研究，探讨不同OH模式与死亡率之间的关系。
