老年人的体位性血压变化和相关危险因素的初探

目的了解体位性血压异常波动在老年人群中的发生情况，探讨相关危险因素及靶器官损伤情况。方法对106例老年人进行卧位及立位3min内血压测定，根据血压变化情况分为体位性低血压（OHYPO）组、体位性高血压（OHT）组及体位性血压正常（ONT）组。分析各组的临床资料、生化指标、颈动脉超声、心脏超声检查结果。结果106例患者中，发现OHYPO组10例（9．4％），OHT组30例（28．3％）。OHYPO组合并帕金森氏病及应用抗震颤药物者比例高于ONT组（P〈0．01）及OHT组（P〈0．05）；OHT组应用硝酸酯类药物者比例高于其他两组（P〈0．05），该组三酰甘油高于OHYPO组（P〈0．05），高密度脂蛋白低于ONT组（P〈0．05）；多元回归分析结果显示使用硝酸酯类药物、低高密度脂蛋白血症是体位性高血压的独立危险因素。OHT组左房内径大于ONT组（P〈O．01），OHYPO组内生肌酐清除率低于OHT组（P〈O．05）。结论体位性血压异常波动在老年人中较常见，这可能与老年人血脂异常、合并疾病及使用药物增多相关。剧烈的血压变化对老年人左心房及肾小球滤过功能造成的损伤较明显。

Investigation of orthostatic blood pressure changes and associated risk factors in the elderly patients

Objective To observe the incidence of abnormal orthostatic blood pressure changes, associated risk factors and target organ damage in the elderly people. Methods Blood pressure measurements of 106 elderly patients were obtained in a supine position and within 3 minutes after standing. 106 cases were divided into orthostatic hypotension （OHYPO） group, orthostatic hypertension （OHT） group and orthostatic normotension （ONT） group according to the blood pressure levels. Clinical status, biochemical indicator, carotid ultrasound and echocardiogram were evaluated and analyzed at the same time. Results Among 106 patients, 10 （9.4%） and 30 （28.3%） cases in OHYPO and OHT groups were found, respectively. OHYPO group had a higher incidence of Parkinson disease （PD） and more use of anti-PD medicine, as compared with ONT group （P 〈0.01 ） and OHT group （P 〈0.05 ）, respectively. While more patients in OHT group used nitrates than other two groups （P 〈0.05 ）, and had a higher TG levels compared with patients in OHYPO group （P 〈0.05 ）, a lower HDL levels compared with those in ONT group （P 〈0.05 ）. Multi-factor linear regression analysis showed that the use of nitrates and low HDL levels were the independent risk factors of OHT. OHT group had larger left atrium diameter than that of ONT group （P 〈0.01 ）. Moreover, creatinine clearance rate （Ccr） of OHYPO group was lower than that of OHT group （P 〈0.05 ）. Conclusions Abnormal orthostatic blood pressure change is common in the elderly people, which might be related to the abnormity of blood lipid, an increase in the number of complications and use of drugs. The severe fluctuation of blood pressure seems to damage left atrium and glomerular filtration apparently in the elderly patients.