Fotherby M D, Potter J F
University Department of Medicine and Therapeutics, Glenfield General Hospital, Leicester, UK.
Postgrad Med J. 1994 Dec;70(830):878-81. doi: 10.1136/pgmj.70.830.878.
The effect of withdrawing or continuing anti-hypertensive therapy on orthostatic blood pressure change in elderly hypertensive subjects was examined. Subjects meeting criteria for therapy withdrawal had supine and standing blood pressure measurements taken on treatment, and at 1, 3, 6, 9 and 12 months off treatment whilst receiving standard non-pharmacological advice to lower blood pressure. Subjects not meeting blood pressure criteria for treatment withdrawal or were unwilling to stop treatment had blood pressure measurements taken after 6 and 12 months whilst also receiving non-pharmacological advice. Orthostatic hypotension was defined as a mean systolic blood pressure fall > or = 20 mmHg on standing from a supine position. Forty-seven subjects (median age 76 years, range 65-84 years) had treatment withdrawn. Thirteen subjects (median age 73 years, range 68-82 years) continued on their treatment. Twelve months after treatment withdrawal there was a significant reduction in the number demonstrating orthostatic hypotension from 11 (23%) to four (11%) (P < 0.05), whilst the group continuing on treatment showed no change. In the withdrawal group those with orthostatic hypotension on treatment (n = 11) were older (79 versus 74 years, P = 0.05), had higher prewithdrawal systolic blood pressure (164 +/- 21 versus 147 +/- 17 mmHg, P = 0.02) compared to those without, although there was no difference in body mass index, gender, number or type of anti-hypertensive drugs taken. In elderly hypertensive subjects withdrawal of anti-hypertensive therapy and institution of non-pharmacological treatment can over several months reduce the prevalence of orthostatic hypotension.
研究了停用或继续抗高血压治疗对老年高血压患者直立性血压变化的影响。符合治疗停药标准的受试者在治疗期间以及停药后1、3、6、9和12个月进行仰卧位和站立位血压测量，同时接受降低血压的标准非药物建议。不符合治疗停药血压标准或不愿停药的受试者在6个月和12个月后进行血压测量，同时也接受非药物建议。直立性低血压定义为从仰卧位站立时平均收缩压下降≥20 mmHg。47名受试者（年龄中位数76岁，范围65 - 84岁）停药。13名受试者（年龄中位数73岁，范围68 - 82岁）继续治疗。停药12个月后，出现直立性低血压的人数从11人（23%）显著减少至4人（11%）（P < 0.05），而继续治疗组无变化。在停药组中，治疗时出现直立性低血压的患者（n = 11）年龄更大（79岁对74岁，P = 0.05），停药前收缩压更高（164 ± 21 mmHg对147 ± 17 mmHg，P = 0.02），与未出现直立性低血压的患者相比，尽管在体重指数、性别、服用的抗高血压药物数量或类型方面无差异。对于老年高血压患者，停用抗高血压治疗并采用非药物治疗数月后可降低直立性低血压的患病率。
