老年体位性低血压与心血管疾病风险的关系

目的 研究老年体位性低血压(OH)与心血管疾病风险及住院率的关系。方法 对长期居住广州的军队离退休老年人进行健康普查,选取65岁以上的1174人进行立卧位血压及心率的测量,其中男1122人,女52人。OH诊断标准：从卧位转为立位后3 min内收缩压下降≥20 mm Hg和（或）舒张压下降≥10 mm Hg;采用电话随访,观察OH与新发心血管事件及住院率的关系。结果 对上述人群平均(315.8±20.8)d的跟踪随方。OH发生率为25.6％（301例）;OH患者的全因再入院率及心血管相关性住院率均高于非OH患者（45.1％比32.5％;19.1％比7.4％）;OH组心绞痛、心肌梗死的发生率高于非OH组（7.5％比3.7％;4.8％比0.5％,P＜0.05）;Logistic回归校正年龄、坐位心率、卧位血压及既往心脑血管病史后,OH与心绞痛（HR:2.122,95％ CI:1.184～3.802）、心肌梗死（HR:8.995,95％ CI:2.909～27.819）的发生仍具有明显的相关性(P=0.011,P=0.000)。结论 OH可增加全因住院率及心血管相关性住院率;OH增加老年人心绞痛、心肌梗死发生的风险。

Correlation between orthostatic hypotension and cardiovascular risks in elderly population

Objective To investigate the correlation between orthostatic hypotensionand cardiovascular risks and hospitalization rate in the elders. MethodsA total of 1174 people over 65 years old underwent health screening physical examination through a self-made questionnaire at our hospital. Their clinical data were collected. The orthostatic blood pressure and heart rate were measured in supine position after resting for over 5 minutes and at 0 and 2 min after standing. Orthostatic hypotension was defined as 20 mm Hg or greater decrease in SBP or/and 10 mm Hg or greater decrease in DBP after standing. All cases were followed up by telephone or hospitalization medical records for a mean period of 315.8 days. The primary endpoint was the occurrence of such cardiovascular or cerebrovascular events as angina, fatal or nonfatal myocardial infarction (MI), congestive heart failure, sudden cardiac death, ischemic and hemorrhagic stroke. ResultsThe prevalence of OH was 25. 6％ in this cohort. Significant differences could be found in the rate of all-cause and cardiovascular-related hospitalization between OH positive and OH negative(45. 1％ vs 32. 5％ ;19. 1％ vs 7.4％ ) ; the rates of angina and myocardial infarction in the OH positive group were significantly higher than those in the OH negative group(7. 5％ vs 3. 7％ : 4. 8％ vs 0. 5％, P ＜0. 05 ) ; after adjusting for age, supine blood pressure, heart rate and cerebrovascular history by logistic regression, statistical differences could also be observed between OH and angina P = 0. 011, HR (hazard ratio) : 2. 122,95％ CI (confidence interval): 1. 184- 3.802 and MI (P ＜ 0.001, HR: 8.995, 95％ CI: 2.909- 27.819)].Conclusion Orthostatic hypotension may increase the rates of all-cause and cardiovasular-related hospitalization. And it is a robust predictor of angina and myocardial infarction in the elders.