老年高血压合并体位性低血压患者发生心脑血管事件的危险因素分析

目的 探讨老年高血压合并体位性低血压(OH)患者发生心脑血管事件的危险因素.方法 选取2018年1月至2020年 1月我院收治的老年高血压合并OH患者135例作为研究对象,对患者进行为期1年的随访,根据是否发生主要心脑血管事件将患者分为事件组(52例)和无事件组(83例).比较两组患者的性别、年龄、体质量指数(BMI)...     

老年高血压患者体位性低血压影响因素分析

目的:分析老年高血压患者体位性低血压(OH)的影响因素。方法:病例对照研究,入选65岁及以上因高血压住院的老年患者224例,对其进行卧位和站立位0 min、1 min、2 min和3 min的血压测量。OH定义为直立3 min内收缩压下降≥20 mmHg(1 mmHg＝0.133 kPa)和(或)舒张压下降≥10 mm...     

体位性低血压节律评估在老年高血压患者护理中的应用

目的研究体位性低血压节律评估在老年高血压患者护理中的应用效果。方法回顾性分析2018年4月至2019年3月期间本院接收的76老年高血压患者的临床资料,根据是否发生体位性低血压分为对照组(单纯性高血压)38例、观察组(体位性低血压)38例。将两组的血压节律特点进行比对,根据血压节律特点实施针对性护理。结果观察组患者的夜间舒张压、夜间舒张压均低于对照组,差异具有统计学意义(P<0.05),两组患者的全天和日间舒张压、收缩压进行比较差异无统计学意义(P>0.05)。结论体位性低血压节律评估可为老年高血压患者护理方法的调整提供指导,预防或减少体位性低血压的发生。     

体位性低血压对老年心力衰竭患者长期预后的影响

目的 探讨体位性低血压(OH)对老年心力衰竭(HF)患者长期不良心脑血管事件(MACCE)的影响,并分析影响MACCE的危险因素. 方法 回顾性队列研究,连续纳入2015年1月至2018年1月在我院诊治的老年HF患者.依据是否合并OH,选择100例合并OH的HF患者为OH组,并按照1∶2比例选择年龄和左室射血分数匹配的...     

老年高血压病患者体位性低血压发生及影响因素分析

为了解老年高血压病患者服用降压药后体位性低血压发生情况及影响因素 ,我们对 82例老年高血压患者服用降压药后 1.5 h及 4 h分别进行了卧立位血压及心率的测量 ,观察其血压变化情况。1　对象及方法1.1　 对象　老年高血压患者 82例 ,男 6 0例 ,女 2 2例 ,年龄 6 0～ 85岁 (平均 71.6± 5 .4岁 )。按“中国高血压防治指南”中诊断标准诊断并进行 3级分级。对照组 37例 ,男 16例 ,女 2 1例。年龄 6 0～ 78岁 (平均 6 8.1± 5 .0岁 ) ,无高血压、糖尿病病史。1.2 　 方法1.2 .1　 分组　按年龄分为≤ 70岁、≥ 70岁两组 ;按疾病分为糖尿病及非…     

体位性低血压的危险因素及发病机制研究进展

体位性低血压的危险因素复杂,发病机制尚不明确,目前多倾向于压力反射敏感性降低、自主神经功能障碍、血流动力学异常等学说。本文主要对其危险因素及发病机制做一综述。     

老龄高血压患者血压变异性和体位性低血压的相关性

目的 对老龄高血压患者血压变异性和体位性低血压之间的相关性进行分析.方法 选取180例老龄高血压患者,对其数据资料进行分析,分析血压变异性与体位性低血压之间的关系.结果 ①第3三分位患者年龄、收缩压、饮酒高于第1三分位;第3三分位患者收缩压高于第2三分位(P<0.05);其他数据比较无差异(P>0.05).②第3三分位收缩压、舒张压与体位性低血压检出率均高于第1与第2三分位患者(P<0.05).③与第1三分位比较,第3三分位是体位性低血压的危险因素;模型2在模型1的基础上校正年龄、性别,第3三分位为体位性低血压的危险因素;模型3在模型2的基础上校正收缩压、BMI、饮酒等,第3三分位是体位性低血压的阴险因素.结论 老老龄高血压患者血压变异与体位性低血压有着很大的相关性.     

高龄老人高血压的治疗现状及体位改变的相关因素

目的探讨高龄老人高血压的治疗现状及体位改变的相关因素。方法选择2015年1~7月高龄老人2 000例进行问卷调查,观察患者降压药物使用情况、随访血压情况、影响降压治疗的因素以及体位性低血压(OH)和体位性高血压(OHT)与心血管疾病的关系。结果高龄老人高血压患者使用的降压药物包括:钙拮抗剂(54.73%)、血管紧张素转换酶抑制(16.25%)、血管紧张素受体抑制剂(17.04%)、利尿剂(6.82%)、β受体阻滞剂(3.54%)和其他药物(1.62%)。患者血压测量主要在医院/医疗机构测量(51.07%)和家庭自测(36.14%)。大多数患者坚持每天、每月血压测量(96.82%),部分患者每年一次或者从不进行血压监测(3.18%)。908例高龄高血压患者中,诊断为OH者298例(32.82%),OHT者171例(18.83%)。OH组、OHT组患者冠心病、高脂血症、糖尿病和脑卒中的患病率均高于非OH/OHT组(P0.05)。结论高龄老人高血压的治疗药物中,钙拮抗剂、肾素血管紧张素系统阻断剂得到广泛认同,而利尿剂的使用相对不足,患者自我管理模式的实行有待加强,冠心病、高脂血症、糖尿病、脑卒中均与体位改变有关。     

Influencing factors and hemodynamic study of initial and sustained orthostatic hypotension in middle‐aged and elderly patients

Orthostatic hypotension (OH) is a common autonomic disorder. This study aimed to investigate the influencing factors and hemodynamic mechanisms of initial and sustained OH in middle‐aged and elderly patients. The authors analyzed the clinical characteristics and hemodynamic variables of patients aged ≥ 50 years according to the various forms of OH, diagnosed by an active orthostatic test using the CNAP monitor. The study included 473 participants; 119 (25.2%) patients had initial (54, 45.4%) or sustained (65, 54.6%) OH. Age, comorbidities, or medications did not differ significantly between the initial OH and non‐OH groups. Sustained OH was associated with age and diabetes (p = .003 and p = .015, respectively). Hemodynamic analysis revealed higher cardiac output (CO) in the sustained OH group within 15 s than in the non‐OH and initial OH groups (both p < .001); no difference in CO was observed between the initial OH and non‐OH groups. The systemic vascular resistance (SVR) in both initial OH and sustained OH groups within 15 s was lower than that in the non‐OH group (both p < .001). No differences in SVR at 3 min were observed between the initial OH and non‐OH groups. The SVR at 3 min in the sustained OH group was significantly lower than in non‐OH and initial OH groups (both p < .001). Age and diabetes emerged as the independent risk factors associated with sustained OH. Initial OH is associated with a mismatch of increase in CO and decrease in SVR. Sustained OH is mainly associated with sustained inadequate adjustment in SVR.     

Arterial stiffness is associated with orthostatic hypotension in elderly subjects with history of falls

OBJECTIVES: To test the hypothesis that impaired hemodynamic orthostatic changes commonly observed in the elderly may be related to age-related increase in arterial wall stiffness. DESIGN: Convenience sample of consecutive patients admitted for falls. SETTING: Acute- and intermediate-care geriatric ward of a French hospital. PARTICIPANTS: Fifty-seven elderly patients (46 women) consecutively admitted to a geriatric ward with a history of recent falls. MEASUREMENTS: Orthostatic hypotension (OH) was assessed using blood pressure measurements in the supine position and 1, 2, and 3 minutes after standing. Arterial wall stiffness was assessed using upper-limb and aortic pulse-wave velocities, measured with an external pressure transducer connected to a computer. RESULTS: OH was present in 18 patients with a mean age+/-standard deviation of 85.4+/-7.6 (5 men, 13 women) and absent in 39 patients aged 83.7+/-6.2 (6 men, 33 women). Upper-limb pulse-wave velocity was significantly higher, by 16%, in patients with OH than those without (9.91 vs 8.53 m/s; P<.02). Significant correlations were found between upper-limb pulse-wave velocity and systolic blood pressure changes after 1 minute of standing (r=0.263, P<.05) and maximal diastolic blood pressure change after standing (r=0.351, P<.01). CONCLUSION: Upper-limb arterial wall stiffness was significantly greater in elderly patients with OH than in patients without OH and was significantly related to blood pressure changes after standing. These results highlight the possible role of age-related changes in the arterial tree in the hemodynamic response to orthostatic challenges.     

Associations of the systolic and diastolic components of orthostatic hypotension with markers of cardiovascular risk in older men: A cross‐sectional analysis from The British Regional Heart Study

The mechanisms underlying the association between orthostatic hypotension (OH) and cardiovascular disease are unclear. We investigated whether OH is associated with circulating cardiovascular risk markers. This was a cross‐sectional analysis of 3857 older, community‐dwelling men. “Consensus OH” was defined as a sitting‐to‐standing decrease in systolic blood pressure ≥20 mm Hg and/or diastolic blood pressure ≥10 mm Hg that occurred within three minutes of standing. Multiple generalized linear regression and logistic models were used to examine the association between cardiovascular risk markers and OH. Consensus OH was present in 20.2%, consisting of isolated systolic OH in 12.6%, isolated diastolic OH in 4.6%, and combined systolic and diastolic OH in 3.0%. Concentration of von Willebrand factor, a marker of endothelial dysfunction, was positively associated with isolated systolic OH (OR 1.35, 95% CI 1.05‐1.73) and combined systolic and diastolic OH (OR 2.27, 95% CI 1.35‐3.83); high circulating phosphate concentration, which may reflect vascular calcification, was associated with isolated diastolic OH (OR 1.53, 95% CI 1.04‐2.25) and combined systolic and diastolic OH (OR 2.12, 95% CI 1.31‐3.44), high‐sensitivity troponin T, a marker of myocardial injury, was positively associated with isolated diastolic OH (OR 1.69, 95% CI 1.07‐2.65) and N‐terminal pro‐brain natriuretic peptide, a marker of cardiac stress, was positively associated with combined systolic and diastolic OH (OR 2.14, 95% CI 1.14‐4.03). In conclusion, OH is associated with some cardiovascular risk markers implicated in endothelial dysfunction, vascular calcification, myocardial injury, and cardiac stress. Clinicians should consider assessing cardiovascular risk in patients with OH.     

Hypertension, orthostatic hypotension, and the risk of falls in a community-dwelling elderly population: the maintenance of balance, independent living, intellect, and zest in the elderly of Boston study

OBJECTIVES: To investigate the relationships between uncontrolled and controlled hypertension, orthostatic hypotension (OH), and falls in participants of the Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly of Boston Study (N=722, mean age 78.1). DESIGN: Prospective population‐based study. SETTING: Community. PARTICIPANTS: Seven hundred twenty‐two adults aged 70 and older living within a 5‐mile radius of the study headquarters at Hebrew Rehabilitation Center in Boston. MEASUREMENTS: Blood pressure (BP) was measured at baseline in the supine position and after 1 and 3 minutes of standing. Systolic OH (SOH) and diastolic OH at 1 and 3 minutes were defined as a 20‐mmHg decline in systolic BP and a 10‐mmHg decline in diastolic BP upon standing. Hypertension was defined as BP of 140/90 mmHg or greater or receiving antihypertensive medications (controlled if BP<140/90 mmHg and uncontrolled if ≥140/90 mmHg). Falls data were prospectively collected using monthly calendars. Fallers were defined as those with at least two falls within 1 year of follow‐up. RESULTS: OH was highest in participants with uncontrolled hypertension; SOH at 1 minute was 19% in participants with uncontrolled hypertension, 5% in those with controlled hypertension, and 2% in those without hypertension (P≤.001)). Participants with SOH at 1 minute and uncontrolled hypertension were at greater risk of falls (hazard ratio=2.5, 95% confidence interval=1.3–5.0) than those with uncontrolled hypertension without OH. OH by itself was not associated with falls. CONCLUSION: Older adults with uncontrolled hypertension and SOH at 1 minute are at greater risk for falling within 1 year. Hypertension control, with or without OH, is not associated with greater risk of falls in older community‐dwelling adults.     

高血压患者合并抑郁的危险因素分析

目的 通过对高血压合并抑郁患者群体指标的分析,探讨高血压患者合并抑郁的危险因素。方法 选取高血压合并抑郁患者和单纯高血压患者各110例,收集并比较两组患者的一般资料及各血清因子水平。筛选单因素分析有统计学意义的变量进行多因素Logistic回归分析。结果 单因素分析显示,高血压合并抑郁患者的皮质醇(Cor)和肾素前体(Rep)水平显著升高,血红素加氧酶1(HO-1)水平显著降低,差异有统计学意义(P＜0.05),两组间其他指标差异无统计学意义。对单因素分析筛选出的上述3个变量采用非条件多因素Logistic回归分析发现,HO-1水平降低(OR=0.012,95%CI:0.001~0.251,P＜0.01)和Rep水平升高(OR=5.979,95%CI:3.054~11.706,P＜0.001)是高血压患者合并抑郁的重要危险因素。结论 HO-1水平下降和Rep水平升高是高血压患者合并抑郁的重要危险因素。