Geng Hui, Fang Dingfeng, Chen Xiahuan, Liu Meilin
Department of Geriatrics, Peking University First Hospital, Beijing, China.
Peking University Health Science Center, Beijing, China.
J Clin Hypertens (Greenwich). 2025 Feb;27(2):e14976. doi: 10.1111/jch.14976.
Classic orthostatic hypotension (OH) is a common geriatric disorder and is associated with cardiovascular risk. There is so far too few data available on the prognostic importance of initial OH and the comparison with sustained OH. This study investigated cardiovascular outcomes in initial and sustained OH in a cohort of patients aged ≥50 years. The study included 435 participants; 94 (21.6%) patients had initial (43, 45.7%) or sustained (51, 54.3%) OH, diagnosed by an active orthostatic test using the CNAP monitor. The median follow-up period was 65 months (inter-quartile range, 30 to 71). One hundred and fifty-nine (36.6%) of the patients had the primary outcome (a composite of major adverse cardiovascular events [MACE] and death from any cause), among which 142 (32.6%) had MACE, and 21 (4.8%) died. Analysis through Kaplan-Meier and further Cox regression models for multivariable adjustment both showed that, initial OH increased both the risk of the primary outcome and MACE (HR 2.20, 95% CI 1.39 to 3.50; HR 2.38, 95% CI 1.48 to 3.84), while didn't increase the mortality. In contrast, sustained OH increased both the risk of the primary outcome and MACE (HR 1.77, 95% CI 1.17 to 2.69; HR 1.71, 95% CI 1.09 to 2.70), as well as the mortality (HR 3.32, 95% CI 1.29 to 8.50). In conclusion, the preliminary exploration of this relatively small-sample study indicates that, OH, no matter initial or sustained OH, increased the cardiovascular risk in patients aged ≥50 years, while only sustained OH increased the risk of mortality.
经典体位性低血压（OH）是一种常见的老年疾病，与心血管风险相关。目前，关于初始OH的预后重要性以及与持续性OH的比较，可用数据太少。本研究调查了≥50岁患者队列中初始OH和持续性OH的心血管结局。该研究纳入了435名参与者；94名（21.6%）患者患有初始（43名，45.7%）或持续性（51名，54.3%）OH，通过使用CNAP监测仪的主动体位试验进行诊断。中位随访期为65个月（四分位间距，30至71个月）。159名（36.6%）患者出现主要结局（主要不良心血管事件[MACE]和任何原因导致的死亡的复合结局），其中142名（32.6%）发生MACE，21名（4.8%）死亡。通过Kaplan-Meier分析以及进一步的多变量调整Cox回归模型均显示，初始OH增加了主要结局和MACE的风险（风险比[HR]2.20，95%置信区间[CI]1.39至3.50；HR 2.38，95%CI 1.48至3.84），但未增加死亡率。相比之下，持续性OH增加了主要结局和MACE的风险（HR 1.77，95%CI 1.17至2.69；HR 1.71，95%CI 1.09至2.70），以及死亡率（HR 3.32，95%CI 1.29至8.50）。总之，这项相对小样本研究的初步探索表明，OH，无论是初始OH还是持续性OH，均增加了≥50岁患者的心血管风险，而只有持续性OH增加了死亡风险。
