Räihä I, Luutonen S, Piha J, Seppänen A, Toikka T, Sourander L
Department of Geriatrics, University of Turku, Finland.
Arch Intern Med. 1995 May 8;155(9):930-5. doi: 10.1001/archinte.1995.00430090067008.
To determine the prevalence and predisposing factors of postural hypotension and to evaluate the effect of postural hypotension on 10-year vascular mortality in an elderly population.
A random sample of 480 subjects aged 65 years or older was obtained in 1982. The participation rate of the subjects in the study was 72%, for a total of 347 subjects. Orthostatic testing and continuous ambulatory electrocardiographic recording, as well as comprehensive clinical evaluation, including medical history, physical examination, standard electrocardiography, chest radiography, blood pressure measurement, routine biochemical analysis, and determination of body mass index, were performed. In 1992, the 10-year mortality of subjects and causes of death were recorded from the mortality statistics. Of the participants, 184 (53%) had died and 163 were still alive. To determine the effect of postural hypotension on the 10-year mortality, the subjects who were alive and those who had died of vascular or nonvascular causes were compared. All of the examinations had been completed in 156 subjects who were still alive, in 109 subjects who had since died of vascular causes, and in 64 subjects who had died of nonvascular causes.
An abnormal postural systolic blood pressure drop (-20 mm Hg or less) after standing for 3 minutes was demonstrated in 28.0% of subjects. There were no sex or age differences between the subjects with and without postural hypotension. No predisposing factors for postural hypotension other than elevated blood pressure were found. Chronic cardiovascular diseases, disability, body mass index, medication, and abnormal findings in ambulatory electrocardiographic monitoring were not associated with postural hypotension. In the univariate analysis, the extent of systolic or mean blood pressure change predicted neither vascular nor nonvascular death during the 10-year follow-up. On the other hand, diastolic blood pressure drop, in particular after standing for 1 minute, was associated with increased vascular mortality (odds ratio, 2.7; 95% confidence interval, 1.3 to 5.6). In the multivariate analysis, however, this association disappeared.
Postural hypotension was common in an unselected elderly population. No predisposing factors for postural hypotension other than elevated blood pressure were found. The 10-year follow-up showed that postural diastolic, but not systolic, blood pressure drop predicted excess vascular mortality. However, this association disappeared in the multivariate analysis, thus being related to background factors such as cardiovascular diseases.
确定体位性低血压的患病率及易感因素，并评估体位性低血压对老年人群10年血管性死亡率的影响。
1982年对480名65岁及以上的受试者进行随机抽样。受试者的参与率为72%，共347名受试者。进行了直立试验、动态心电图连续记录以及全面的临床评估，包括病史、体格检查、标准心电图、胸部X线检查、血压测量、常规生化分析以及体重指数测定。1992年，从死亡率统计中记录受试者的10年死亡率及死亡原因。在参与者中，184人（53%）已死亡，163人仍存活。为确定体位性低血压对10年死亡率的影响，对存活者以及死于血管性或非血管性原因的人进行了比较。所有检查均在156名仍存活的受试者、109名随后死于血管性原因的受试者以及64名死于非血管性原因的受试者中完成。
28.0%的受试者在站立3分钟后出现异常的体位性收缩压下降（-20 mmHg或更低）。有体位性低血压和无体位性低血压的受试者之间不存在性别或年龄差异。除血压升高外，未发现体位性低血压的其他易感因素。慢性心血管疾病、残疾、体重指数、药物治疗以及动态心电图监测中的异常发现与体位性低血压无关。在单因素分析中，收缩压或平均血压变化程度在10年随访期间均未预测血管性或非血管性死亡。另一方面，舒张压下降，尤其是站立1分钟后的舒张压下降，与血管性死亡率增加相关（比值比，2.7；95%置信区间，1.3至5.6）。然而，在多因素分析中，这种关联消失了。
在未经过筛选的老年人群中，体位性低血压很常见。除血压升高外，未发现体位性低血压的其他易感因素。10年随访显示，体位性舒张压而非收缩压下降预示着血管性死亡率过高。然而，这种关联在多因素分析中消失了，因此与心血管疾病等背景因素有关。
