老年人体位性血压变化与靶器官损害的相关性研究

目的观察老年人体位性血压变化的发生率,探讨其与靶器官损害的关系。方法选择190例老年人,根据体位性血压变化情况分为3组：体位性低血压（OH）组、体位性正常血压（ONT）组和体位性高血压（OHT）组,并进行生化、颈动脉超声、动脉硬化指标检测。结果190名老年人中OH发生率19．47％,OHT发生率20％。与ONT组相比,OH组患者颈动脉内膜中层厚度（IMT）升高（ONT组和OH组IMT分别为（0．85±0．02）cm、（0．97±0．04）cm,P〈0．05）、肾小球滤过率（CCR）下降（ONT组和OH组CCR分别为（70．68±2．29）mL／min、（62．14±3．36）mL／min,P〈0．05）、肱踝脉搏波传导速度（baPWV）升高（ONT组和OH组baPWV分别为（1872．36±21．17）mm／s、（2165．40±37．01）mm／s,P〈0．05）;而OHT组患者baPWV升高（OHT组baPWV为（2109．45±36．22）mm／s,P〈0．05）。结论老年人OHT与OH患病率较高,体位性血压变化与靶器官损害相关。     

老年人体位性血压变化与脉搏波传导速度的相关分析

目的 观察老年人体位改变导致血压异常波动的发生率,研究体位性血压变化与脉搏波传导速度（PWV）之间的关系.方法 选择165名老年人进行平卧位、立位3 min内血压测定,据血压变化情况分成3组：体位性低血压（OH）组、体位性正常血压（ONT）组和体位性高血压（OHT）组,采用动脉硬化榆测仪榆测双侧肱踝脉搏波传导速度（baPWV）.结果 165名老年人中,OH组33例 （20%）,ONT组101例（61.2%）.OHT 组31例（18.8%）.与ONT组相比,OH组、OHT组baPWV有升高（P〈0.05）.结论老年人体位性血压变化发生率较高;这种体位性血压变化与大动脉弹性下降有关,并可能与心血管事件发生率相关.     

体位性低血压与血压昼夜节律的相关性

目的 探讨体位性低血压(OH)与血压昼夜节律的相关性。方法 选择2019年8月至2021年12月于福州市长乐区医院心血管内科住院检查治疗的原发性高血压患者244例,根据卧立位血压检测结果,分为非OH组193例,OH组51例。入选对象均行24 h动态血压监测。分析OH与血压昼夜节律的相关性。结果 与非OH组比较,OH组年龄、糖尿病史、卧位收缩压较高(均P<0.05),立位1 min收缩压、立位3 min收缩压、夜间收缩压下降率较低(均P<0.05)。按血压节律分组,超杓型、杓型、非杓型、反杓型人群OH的检出率分别为8.0%(2/25)、11.7%(8/68)、21.6%(24/111)、42.5%(17/40,χ²=17.272,P=0.001)。按年龄分层,非老年组(年龄<65岁)与老年组(年龄≥65岁)OH检出率差异无统计学意义[12.8%(10/78)比24.7%(41/166),χ²=3.078,P=0.079],但老年组的夜间收缩压下降率高于非老年组[(10.9±7.4)%比(7.2±8.4)%,t=3.324,P=...     

焦虑抑郁状态对老年高血压患者动态血压影响的研究

目的探讨老年高血压伴发抑郁焦虑情绪患者的24h动态血压变化规律。方法选择老年高血压患者120例,进行抑郁自评量表和焦虑自评量表的心理问卷调查及汉密尔顿抑郁量表和汉密尔顿焦虑量表的评定,根据评分结果分为抑郁焦虑组75例和无抑郁焦虑组45例,对所有研究对象进行24h动态血压监测,并对结果进行比较分析。结果抑郁焦虑组24h收缩压、昼间收缩压、夜间收缩压明显高于无抑郁焦虑组[(136.0±14.6)mm Hg(1mm Hg=0.133kPa)vs(126.0±13.4)mm Hg,(139.0±15.2)mm Hg vs(130.0±13.6)mm Hg,(132.0±13.6)mm Hg vs(123.0±12.5)mm Hg,P<0.01]。抑郁焦虑组24h收缩压标准差、昼间收缩压标准差及24h收缩压加权标准差显著高于无抑郁焦虑组[(14.78±1.62)mm Hg vs(14.07±1.80)mm Hg,(13.25±2.94)mm Hg vs(12.28±3.05)mm Hg,(14.07±1.37)mm Hg vs(10.81±1.91)mm Hg,P<0.05,P<0.01]。结论有抑郁焦虑情绪的老年高血压患者血压变异性显著高于无抑郁焦虑高血压患者。     

老年高血压患者焦虑抑郁情绪对血压的影响

目的观察老年高血压患者焦虑抑郁情绪对血压的影响。方法选取2010²012年收治的120例老年高血压患者,经焦虑自评量表(SAS)、抑郁自评量表(SDS)评定后,根据有无焦虑抑郁情绪分为焦虑抑郁组(64例)和非焦虑抑郁组(56例),比较两组患者的一般资料及动态血压。结果焦虑抑郁组患者24 h平均收缩压(24 h SBP)、24 h平均舒张压(24 h DBP)、白昼平均收缩压(dSBP)、白昼平均舒张压(dDBP)、夜间平均收缩压(nSBP)、夜间平均舒张压(nDBP)、动态脉压(APP)、清晨收缩压(清晨SBP)、夜间最低收缩压(夜最低SBP)、血压晨峰(MBPS)、血压昼夜节律(CR)以及非勺型血压的发生率均明显高于非焦虑抑郁组患者(P<0.05)。结论焦虑抑郁情绪会导致原发性高血压患者动态血压水平和非勺型血压的发生率增高,因此针对已出现焦虑抑郁情绪的患者应及时给予抗焦虑抑郁治疗,有效控制血压。     

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。     

132例老年人体位性血压变化的观察

测量107例60岁以上老年人血压，其躺位平均血压为17.57&;#177;2.72/10.3&;#177;1.6kPa与立位30秒钟后的血压17.07&;#177;2.9／10.03&;#177;16kPa比较，有统计学差异（P&;lt;0.05)。心超异常表现者94例，躺位到立位有收缩压下降大于3kPa的有14例，与心超正常表现13例中有体位性血压改变大于3kPa1例比较，统计学有显著差异（P&;lt;0.05)。另选25例高血压老年人，其躺位收缩压与立位30秒、1～5分钟血压比较，统计学上有极显著差异（P&;lt;0.001）。     

动态血压监测对老年体位性低血压评价的探讨

目的探讨动态血压监测（ABPM）技术对老年体位性低血压的评价价值。方法对152例门诊老年人进行卧位及立位3min血压测量,根据血压变化将患者分为体位性低血压组及非体位性血压组。对所有患者进行动态血压监测,计算并比较两组全天、白天以及夜间的平均血压、平均脉压、血压负荷、血压变异系数、动态动脉硬化指数以及24h血压昼夜节律。结果体位性低血压组的夜间平均收缩压、夜间平均舒张压、夜间收缩压负荷、夜间舒张压负荷、全天收缩压变异系数均高于非体位性低血压组,血压昼夜节律以反杓型为主。结论动态血压监测在老年体位性低血压的用药指导中有着重要的临床作用;老年体位性低血压存在夜间高血压、卧位高血压、收缩压波动范围大、血压昼夜节律异常的特点,上述特征均可造成重要靶器官的损伤。     

体位性血压变化与原发性高血压患者彩超下颈动脉内膜中层厚度、斑块形成情况的相关性分析

目的 探讨体位性血压变化与原发性高血压患者彩超下颈动脉内膜中层厚度、斑块形成情况的相关性。方法 回顾性分析2021年3月至2022年3月在本院确诊的176例原发性高血压患者,根据高血压患者改变体位时血压的变化情况分为体位性高血压组（n=42）、体位性血压正常组（n=80）和体位性低血压（n=54）,分别通过彩超检查所有受试人员的下颈动脉内膜中层厚度、狭窄程度、斑块形成情况并进行比较。结果 体位性高血压组患者的颈动脉内膜中层厚度较体位性血压正常组和体位性低血压组高,狭窄程度较体位性血压正常组和体位性低血压组严重,组间差异有意义（P<0.05）;体位性低血压组患者的颈动脉内膜中层厚度较体位性血压正常组高,狭窄程度较体位性血压正常组严重,组间差异有意义（P<0.05）。体位性高血压组患者的稳定性斑块和不稳定性斑块较体位性血压正常组和体位性低血压组患者多,且斑块数量总分高于体位性血压正常组和体位性低血压组（P<0.05）;体位性低血压组患者的稳定性斑块和不稳定性斑块较体位性血压正常组多,且斑块数量总分高于体位性血压正常组,组间差异有意义（P<0.05）。相关性分析表示：...     

体位变化对老年人血压的影响及护理对策

目的 探讨体位变换对老年人血压的影响及护理对策。方法 观察30例血压正常的青年人(A组)、30例血压正常的老年人(B组)及30例老年高血压患者(C组)体位转换时的血压变化。结果 B组和C组由卧位转为立位时血压下降均较A组明显。结论 体位变化对老年人血压有较大影响;应加强对其生活指导与护理。     

When should orthostatic blood pressure changes be evaluated in elderly: 1st, 3rd or 5th minute?

Detection of orthostatic hypotension (OH) is very important in geriatric practice, since OH is associated with mortality, ischemic stroke, falls, cognitive failure and depression. It was aimed to determine the most appropriate time for measuring blood pressure in transition from supine to upright position in order to diagnose OH in elderly. Comprehensive geriatric assessment (CGA) including Head up Tilt Table (HUT) test was performed in 407 geriatric patients. Orthostatic changes were assessed separately for the 1st, 3rd and 5th minutes (HUT₁, HUT₃ and HUT₅, respectively) taking the data in supine position as the basis. The mean age, recurrent falls, presence of dementia and Parkinson’s disease, number of drugs, alpha-blocker and anti-dementia drug use, and fasting blood glucose levels were significantly higher in the patients with versus without OH; whereas, albumin and 25-hydroxy vitamin D levels were significantly lower (p < 0.05). However, different from HUT₃ and HUT₅, Charlson Comorbidity Index and the prevalence of diabetes mellitus were higher, the use of antidiabetics, antipsychotics, benzodiazepine, opioid and levodopa were more common (p < 0.05). Statistical significance of the number of drugs and fasting blood glucose level was prominent in HUT₁ as compared to HUT₃ (p < 0.01, p < 0.05). Comparison of the patients that had OH only in HUT₁, HUT₃or HUT₅ revealed no difference in terms of CGA parameters. These results suggests that orthostatic blood pressure changes determined at the 1st minute might be more important for geriatric practice. Moreover, 1st minute measurement might be more convenient in the elderly as it requires shorter time in practice.     

Excessive pulse pressure response to standing in community population with orthostatic systolic hypertension

The postural change of pulse pressure (PP) in the persons with orthostatic hypertension (OHT) is unclear. This study included 2849 (65.0 ± 9.3 years) community participants. Blood pressures (BPs) in supine and standing positions were measured. The differences between upright and supine BP and PP were recorded as ΔBP and ΔPP. The criteria for OHT was ΔBP ≥10 mm Hg, for orthostatic hypotension (OH) was ≤−10 mm Hg and for orthostatic normotension (ONT) was −9 to 9 mm Hg. Fasting blood lipids and glucose were measured. The supine SBP of the sOHT group were similar to that of sONT group (140.9 ± 20.2 mm Hg vs 138.2 ± 19.7 mm Hg), but significantly lower than that of sOH group (151.9 ± 19.2 mm Hg; P < .05). Their PPs were 65.3 ± 15.9, 62.8 ± 14.7, and 71.1 ± 15.1 mm Hg, respectively, and with the similar group difference like SBP. When the position changed from supine to standing, the sOHT group showed PP rise, while sOH and sONT groups showed PP reduction (3.8 ± 7.1 mm Hg vs −17.0 ± 8.5 mm Hg and −5.8 ± 6.6 mm Hg; both P < .05). Thus, the standing PP in the sOHT group was significantly higher than in the sONT (69.1 ± 18.0 mm Hg vs 57.0 ± 15.8 mm Hg; P < .05) and in the sOH (54.2 ± 15.2 mm Hg; P < .05) groups. The postural PP profile varies with the postural responses of SBP. The sOHT group has obviously increased PP and significantly higher standing PP compared with the sONT group.     

Hypertension and stress

This study explores the relationship of chronic stress to hypertension. The study included 127 hospitalized and 134 outpatients of a stress treatment program and 129 "normal" persons in the general population. All subjects were matched for age, sex, and race. After three days of hospitalization, there was a 17.3% incidence of hypertension in the hospitalized patients when hypertension was defined as blood pressure levels greater than 140/90 mmHg. These data compare with a 5% and 13% incidence of hypertension in the outpatient stress and "normal" groups, respectively. The National Health Survey of 1962 indicated that 18% of the population were hypertensive. Our data indicate that the incidence of hypertension was no greater in a diagnostically established group of hospitalized stress patients than in the less stressed outpatient or an otherwise "normal" group. The frequently expressed notion that tension and chronic stress predispose a population to essential hypertension is not confirmed by this analysis.     

Non‐interventional weight changes affect systolic blood pressure in normotensive individuals

The association between obesity and hypertension is well established. Weight loss has been shown to reduce blood pressure (BP) among hypertensive patients. Nevertheless, the effect of weight changes on BP in normotensive individuals is less clear. The author explored the association between non‐interventional weight alterations and BP changes in a large cohort of normotensive adults. This is a retrospective analysis of normotensive individuals, between 2010 and 2018. All weight changes were non‐interventional. Body mass index (BMI) and BP were measured annually. Patients were divided according to the change in BMI between visits: reduction of more than 5% ("large reduction"), between 2.5% and 5% ("moderate reduction"), reduction of <2.5% or elevation of <2.5% ("unchanged"), elevation between 2.5% and 5% ("moderate increase"), and elevation of more than 5% ("large increase"). The primary outcome was the change in systolic BP (SBP) between the visits. The final analysis included 8723 individuals. 20% of the patients reduced their BMI by at least 2.5% and 24.5% increased their BMI by more than 2.5%. "High reduction" inferred an absolute decrease of 3.6 mmHg in SBP, while "large increase" resulted in an absolute increase of 1.9 mmHg in SBP. The proportion of individuals with at least 10 mmHg decrease in SBP progressively declined according to the relative decrease in BMI, and the proportion of patients with at least 10 mmHg increase in SBP progressively increased. This effect was more pronounced in individuals with higher baseline SBP. Among normotensive adults, modest non‐interventional weight changes may have significant effects on SBP.