Vanhanen H, Thijs L, Birkenhäger W, Bulpitt C, Tilvis R, Sarti C, Tuomilehto J, Staessen J A
Department of Internal Medicine, University of Helsinki, Finland.
J Hum Hypertens. 1996 Sep;10(9):607-12.
Postural hypotension in older people has been the subject of many studies, but there remains some doubt as to its true prevalence. This study investigated the prevalence and persistency of an exaggerated orthostatic blood pressure (BP) fall in a large group of older patients with isolated systolic hypertension. A total of 2716 patients, 917 men and 1799 women, whose age ranged from 60-100 years, were examined at three separate outpatient visits on a placebo in the single-blind run-in phase of the Syst-Eur Trial. The supine and standing BPs at each visit were the averages of two readings. An exaggerated BP fall was defined as a drop in systolic pressure by at least 20 mm Hg 2 min after assuming the standing from the supine position, or as a drop in the diastolic pressure by at least 10 mm Hg. The reproducibility of orthostatic BP changes was evaluated by the Bland and Altman technique. With the three run-in visits combined, the sitting pressure averaged ( +/- standard deviation) 174 +/- 11 mm Hg systolic and 86 +/- 6 mm Hg diastolic. Systolic pressure fell on average by 5 +/- 12 mm Hg from the supine to the standing position, whereas diastolic pressure increased by 2 +/- 7 mm Hg. The percentage of patients showing an exaggerated orthostatic BP fall was constant at each of the three run-in visits, ie 11-12% for systolic pressure and 4% for diastolic pressure. An exaggerated BP fall at each of the three run-in visits was only present in 3% of the patients for systolic pressure and in 0.4% for diastolic pressure. An exaggerated BP fall at the run-in visits was not associated with dizziness and syncope, which occurred in only 1% of the patients. The orthostatic fall in systolic, but not diastolic pressure, was greater (0.6 mm Hg; P < 0.05) at the second than at the first visit. The repeatability coefficients tended to be higher (60-65%), signifying lower reproducibility, than those for the BP levels (45-55%). An exaggerated fall in systolic or diastolic pressure may occasionally occur in nearly 10% of older patients with isolated systolic hypertension even without antihypertensive drug therapy, but a persistent orthostatic response in only rarely observed.
老年人的体位性低血压一直是许多研究的主题，但对于其真实患病率仍存在一些疑问。本研究调查了一大组单纯收缩期高血压老年患者中直立性血压（BP）过度下降的患病率和持续性。在Syst-Eur试验的单盲导入期，共有2716例患者（917例男性和1799例女性），年龄在60至100岁之间，在三次单独的门诊就诊时接受了安慰剂检查。每次就诊时的仰卧位和站立位血压是两次读数的平均值。血压过度下降定义为从仰卧位变为站立位2分钟后收缩压至少下降20 mmHg，或舒张压至少下降10 mmHg。采用Bland和Altman技术评估直立性血压变化的可重复性。三次导入期就诊综合来看，坐位收缩压平均为（±标准差）174±11 mmHg，舒张压为86±6 mmHg。收缩压从仰卧位到站立位平均下降5±12 mmHg，而舒张压上升2±7 mmHg。在三次导入期就诊中，每次出现血压过度下降的患者百分比保持不变，即收缩压为11% - 12%，舒张压为4%。在三次导入期就诊中，每次收缩压过度下降仅出现在3%的患者中，舒张压过度下降出现在0.4%的患者中。导入期就诊时血压过度下降与头晕和晕厥无关，这些症状仅在1%的患者中出现。第二次就诊时收缩压的直立性下降大于第一次就诊（0.6 mmHg；P < 0.05），但舒张压无此差异。重复性系数往往高于血压水平的重复性系数（45% - 55%），倾向于更高（60% - 65%），这表明可重复性较低。即使在未进行抗高血压药物治疗的情况下，近10%的单纯收缩期高血压老年患者偶尔也可能出现收缩压或舒张压过度下降，但仅很少观察到持续性直立性反应。
