Tilvis R S, Hakala S M, Valvanne J, Erkinjuntti T
Department of Medicine, University of Helsinki, Finland.
J Am Geriatr Soc. 1996 Jul;44(7):809-14. doi: 10.1111/j.1532-5415.1996.tb03738.x.
To evaluate the frequency, risk factors, and prognostic significances of postural hypotension (PH) and dizziness on postural testing (DPT).
A prospective cohort study.
General community, The Helsinki (Finland) Aging Study.
Persons of three age cohorts (75, 80, and 85 years, n = 569) were chosen randomly and followed for 4 years.
Postal questionnaires, structured interview, extensive clinical and laboratory examinations, blood pressure (BP) changes in a postural test using different definitions for PH, history of dizziness, dizziness on testing postural blood pressure reactions (DPT), and date of death during a 4-year follow-up.
The frequency of a fall in systolic blood pressure greater than 20 mm Hg or a fall in diastolic pressure greater than 10 mm Hg (PH-I) was 30.3%. Both criteria occurred simultaneously (PH-II) in 7.5%, and if dizziness on postural testing (DPT) was an additional symptom (PH-III), the prevalence was 2.6%. The overall prevalence of DPT was 19.7%. PH-I, PH-II, and DPT were also frequent among the healthy aged (26.6%, 6.6%, and 17.3%, respectively). The postural change in BP correlated inversely with the initial supine BP levels (systolic r = -.149, P < .001 and diastolic r = -.218, P < .001), but in persons with isolated systolic hypertension PH was rather less frequent (21.9% and 2.3%). DPT was more common in the subjects with heart failure (26.3%, P < .05), impaired exercise tolerance (NYHA III-IV) (33.7%, P < .05), and PH-II (37.2%, P < .05) compared with the healthy controls (17.3%). The 1-year mortality was higher in subjects with than without DPT (7.1% vs 4.8%, P < .05), but the difference was not significant after controlling for age and gender. PH-I, PH-II, and PH-III were not significantly related to 4-year mortality.
In this study of older people in Helsinki, Finland, asymptomatic hypotensive postural BP reactions and DPT were found frequently among healthy older people, and they tended to be increased in people with some diseases. Neither PH nor DPT were of prognostic significance for mortality in this population.
评估体位性低血压（PH）的发生频率、危险因素及其对体位测试时头晕（DPT）的预后意义。
一项前瞻性队列研究。
芬兰赫尔辛基老龄化研究的普通社区。
随机选取三个年龄组（75岁、80岁和85岁，n = 569）的人群，并随访4年。
邮政问卷、结构化访谈、全面的临床和实验室检查、使用不同PH定义的体位测试中的血压（BP）变化、头晕病史、体位性血压反应测试（DPT）时的头晕情况以及4年随访期间的死亡日期。
收缩压下降大于20 mmHg或舒张压下降大于10 mmHg（PH-I）的发生率为30.3%。两种标准同时出现（PH-II）的发生率为7.5%，如果体位测试时头晕（DPT）是附加症状（PH-III），则患病率为2.6%。DPT的总体患病率为19.7%。PH-I、PH-II和DPT在健康老年人中也很常见（分别为26.6%、6.6%和17.3%）。血压的体位变化与初始仰卧位血压水平呈负相关（收缩压r = -0.149，P < 0.001；舒张压r = -0.218，P < 0.001），但在单纯收缩期高血压患者中PH相对较少见（21.9%和2.3%）。与健康对照组（17.3%）相比，DPT在心力衰竭患者（26.3%，P < 0.05）、运动耐量受损（NYHA III-IV级）患者（33.7%，P < 0.05）和PH-II患者（37.2%，P < 0.05）中更常见。有DPT的受试者1年死亡率高于无DPT者（7.1%对4.8%，P < 0.05），但在控制年龄和性别后差异无统计学意义。PH-I、PH-II和PH-III与4年死亡率无显著相关性。
在芬兰赫尔辛基的这项针对老年人的研究中，健康老年人中无症状性体位性低血压反应和DPT很常见，并且在患有某些疾病的人群中往往有所增加。在该人群中，PH和DPT对死亡率均无预后意义。
