Cai Wenqin, Yao Yuexian, Zheng Suli, Chen Wanting, Bao Lingxin, Su Jinzi, Luo Li, Xie Liangdi
Department of Geriatrics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China.
Fujian Hypertension Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China.
J Clin Hypertens (Greenwich). 2025 May;27(5):e70061. doi: 10.1111/jch.70061.
Orthostatic hypotension (OH) is defined as a decrease of ≥20 mm Hg systolic blood pressure (SBP) or ≥10 mm Hg diastolic blood pressure (DBP) within 3 min after standing. OH was associated with an increased risk of major adverse cardiovascular events (MACEs) and mortality. As an indicator reflecting the characteristics of orthostatic blood pressure (BP) changes, there is currently no research available on the relationship between the orthostatic BP drop rate and MACEs or mortality. A total of 448 hospitalized patients (mean age 62.07 ± 12.15 years, 35.49% female) completed the follow-up. The median follow-up duration was 5.09 years (0.29-6.13 years). Ninety-two patients (20.54%) developed OH, 12 patients died (2.68%), and 21 patients developed MACEs (4.69%), including 8 cases of non-fatal acute myocardial infarction (MI), 3 cases of non-fatal stroke, and 10 cases died of cardiovascular disease and stroke. Patients were categorized into the BP group (defined as SBP drop rate 15% and/or DBP drop rate 5% within 3 min after standing) and the BP group (defined as SBP drop rate 15% and DBP drop rate 5% within 3 min after standing). The Chi-square test and Kaplan-Meier survival analysis indicated that the BP group had a higher risk of MACEs and mortality than the BP group (all p 0.05). The Receiver Operating Characteristic (ROC) analysis demonstrated SBP drop rate 15% and/or DBP drop rate 5% within 3 min after standing has high diagnostic accuracy for OH, with an area under the curve (AUC) of 0.918.Cox regression analysis revealed that the cumulative survival rate of the BP group was significantly higher than that of the BP group (98.45% vs. 93.69%, HR 0.304, 95% CI 0.095-0.969, p = 0.044). This study proposes a novel diagnostic threshold (SBP drop ≥15% and/or DBP drop ≥5% within 3 min after standing) for OH as a strong predictor of MACEs and mortality in hospitalized patients. Trial Registration: MRCTA, ECFAH of FMU[2024]490.
直立性低血压（OH）定义为站立后3分钟内收缩压（SBP）下降≥20 mmHg或舒张压（DBP）下降≥10 mmHg。OH与主要不良心血管事件（MACE）和死亡率风险增加相关。作为反映直立性血压（BP）变化特征的指标，目前尚无关于直立性血压下降率与MACE或死亡率之间关系的研究。共有448例住院患者（平均年龄62.07±12.15岁，女性占35.49%）完成了随访。中位随访时间为5.09年（0.29 - 6.13年）。92例患者（20.54%）发生OH，12例患者死亡（2.68%），21例患者发生MACE（4.69%），包括8例非致命性急性心肌梗死（MI）、3例非致命性中风以及10例死于心血管疾病和中风。患者被分为BP组（定义为站立后3分钟内SBP下降率≥15%和/或DBP下降率≥5%）和BP组（定义为站立后3分钟内SBP下降率＜15%且DBP下降率＜5%）。卡方检验和Kaplan - Meier生存分析表明，BP组发生MACE和死亡的风险高于BP组（所有p＜0.05）。受试者操作特征（ROC）分析显示，站立后3分钟内SBP下降率≥15%和/或DBP下降率≥5%对OH具有较高的诊断准确性，曲线下面积（AUC）为0.918。Cox回归分析显示，BP组的累积生存率显著高于BP组（98.45%对93.69%，HR 0.304，95%CI 0.095 - 0.969，p = 0.044）。本研究提出了一种新的OH诊断阈值（站立后3分钟内SBP下降≥15%和/或DBP下降≥5%），作为住院患者MACE和死亡率的强预测指标。试验注册：MRCTA，FMU的ECFAH[2024]490。
