Masaki K H, Schatz I J, Burchfiel C M, Sharp D S, Chiu D, Foley D, Curb J D
Honolulu Heart Program, Kuakini Medical Center, Honolulu, Hawaii, USA.
Circulation. 1998 Nov 24;98(21):2290-5. doi: 10.1161/01.cir.98.21.2290.
Population-based data are unavailable concerning the predictive value of orthostatic hypotension on mortality in ambulatory elderly patients, particularly minority groups.
With the use of data from the Honolulu Heart Program's fourth examination (1991 to 1993), orthostatic hypotension was assessed in relation to subsequent 4-year all-cause mortality among a cohort of 3522 Japanese American men 71 to 93 years old. Blood pressure was measured in the supine position and after 3 minutes of standing, with the use of standardized methods. Orthostatic hypotension was defined as a drop in systolic blood pressure (SBP) of >/=20 mm Hg or in diastolic blood pressure of >/=10 mm Hg. Overall prevalence of orthostatic hypotension was 6.9% and increased with age. There was a total of 473 deaths in the cohort over 4 years; of those who died, 52 had orthostatic hypotension. Four-year age-adjusted mortality rates in those with and without orthostatic hypotension were 56.6 and 38.6 per 1000 person-years, respectively. With the use of Cox proportional hazards models, after adjustment for age, smoking, diabetes mellitus, body mass index, physical activity, seated systolic blood pressure, antihypertensive medications, hematocrit, alcohol intake, and prevalent stroke, coronary heart disease and cancer, orthostatic hypotension was a significant independent predictor of 4-year all-cause mortality (relative risk 1.64, 95% CI 1.19 to 2.26). There was a significant linear association between change in systolic blood pressure from supine position to standing and 4-year mortality rates (test for linear trend, P<0.001), suggesting a dose-response relation.
Orthostatic hypotension is relatively uncommon, may be a marker for physical frailty, and is a significant independent predictor of 4-year all-cause mortality in this cohort of elderly ambulatory men.
关于体位性低血压对非卧床老年患者，尤其是少数族裔群体死亡率的预测价值，目前尚无基于人群的数据。
利用檀香山心脏项目第四次检查（1991年至1993年）的数据，对3522名71至93岁的日裔美国男性队列中，体位性低血压与随后4年全因死亡率的关系进行了评估。采用标准化方法测量仰卧位和站立3分钟后的血压。体位性低血压定义为收缩压下降≥20 mmHg或舒张压下降≥10 mmHg。体位性低血压的总体患病率为6.9%，且随年龄增长而增加。该队列在4年中共有473人死亡；其中52人患有体位性低血压。有和没有体位性低血压者的4年年龄调整死亡率分别为每1000人年56.6和38.6。使用Cox比例风险模型，在调整年龄、吸烟、糖尿病、体重指数、身体活动、坐位收缩压、抗高血压药物、血细胞比容、酒精摄入量以及既往中风、冠心病和癌症后，体位性低血压是4年全因死亡率的显著独立预测因素（相对风险1.64，95%可信区间1.19至2.26）。从仰卧位到站立位收缩压的变化与4年死亡率之间存在显著的线性关联（线性趋势检验，P<0.001），提示存在剂量反应关系。
体位性低血压相对不常见，可能是身体虚弱的一个标志，并且是该老年非卧床男性队列中4年全因死亡率的显著独立预测因素。
