Luutonen S, Antila K, Erkko M, Räihä I, Rajala T, Sourander L
Department of Geriatric Medicine, University of Turku, Finland.
Age Ageing. 1995 Jul;24(4):315-20. doi: 10.1093/ageing/24.4.315.
To examine the haemodynamic mechanism associated with postural hypotension (PH) in elderly people, haemodynamic response to head-up tilt was studied in 14 elderly hypertensives and 13 elderly diabetics. Hypertensives and diabetics were divided into those with or without PH, defined as > or = 10 mmHg decline in mean blood pressure in response to head-up tilt. There was no significant change in cardiac output in hypertensives or diabetics with PH, whereas there was a significant increase during tilt in hypertensives without PH (p < 0.0001) and diabetics without PH (p = 0.0054). Hypertensives without PH showed a significant decrease in total peripheral resistance in response to head-up tilt (p = 0.0043). In hypertensives with PH and in both diabetic groups, there was no change in total peripheral resistance in response to head-up tilt. There was no difference in ejection fractions or heart rate responses between subjects with and without PH in either disease group. The difference in cardiac output change was not explained by myocardial changes observed at echocardiography nor by heart rate response nor by differences in total peripheral resistance. The results suggest that an increase in cardiac output in response to changing posture may be more important than vasoconstriction in protecting elderly subjects from PH.
为研究老年人体位性低血压（PH）相关的血流动力学机制，对14例老年高血压患者和13例老年糖尿病患者进行了头高位倾斜试验的血流动力学反应研究。高血压患者和糖尿病患者根据有无PH进行分组，PH定义为头高位倾斜时平均血压下降≥10 mmHg。有PH的高血压患者或糖尿病患者的心输出量无显著变化，而无PH的高血压患者（p < 0.0001）和无PH的糖尿病患者（p = 0.0054）在倾斜过程中心输出量显著增加。无PH的高血压患者头高位倾斜时总外周阻力显著降低（p = 0.0043）。有PH的高血压患者和两组糖尿病患者头高位倾斜时总外周阻力均无变化。两种疾病组中有PH和无PH的受试者在射血分数或心率反应方面无差异。心输出量变化的差异不能用超声心动图观察到的心肌变化、心率反应或总外周阻力差异来解释。结果表明，在保护老年受试者免受PH影响方面，对姿势变化的心输出量增加可能比血管收缩更重要。
