中老年高血压人群体位性低血压发生率及相关危险因素  

Prevalence and Risk Factors of Orthostatic Hypotension in Middle Aged and Old Hypertensive Patients

作　　者：樊晓寒[1] 孙凯[1] 王建伟[1] 张银辉[1] 娄可佳[1] 周宪良[1] 吴海英[1] 惠汝太 

机构地区：[1]中国医学科学院阜外心血管病医院高血压诊治中心,北京100037

出　　处：《中华高血压杂志》2009年第10期896-900,共5页Chinese Journal of Hypertension

基　　金：863国家高技术研究发展计划(2006AA02Z477)

摘　　要：背景体位性低血压可增加老年患者摔倒、骨折和不良心脑血管事件及死亡。目的通过大样本横断面调查探讨中老年高血压人群体位性低血压发生率及相关危险因素。方法多阶段整群抽样方法调查信阳县7个乡镇5101例40～75岁高血压患者,并测量卧位及立位后0、2 min血压。体位性低血压定义为直立位后3 min内收缩压和(或)舒张压下降≥20/10 mmHg。结果该人群体位性低血压发生率为23.8%(立位0 min:20.1%,2 min:17.2%),女性随年龄增长(40～49、50～59、60～75岁)体位性低血压发生率显著增加(11.8%、16.1%、18.3%,P=0.004);抗高血压药物治疗与未治疗高血压间体位性低血压发生率无显著差异(P>0.05)。Logistic分析调整多种因素后发现,体位性低血压发病危险与冠心病史(OR:1.78,95%CI:1.30～2.48,P<0.01)、脑卒中史(OR:1.40,95%CI:1.06～1.90,P=0.034)和卧位收缩压与舒张压有关,与心室率(OR:0.98,95%CI:0.98～0.99,P=0.001)和坐位血压水平呈负相关。结论体位性低血压在中老年高血压患者中较为常见;合并心血管病可能增加体位性低血压发病危险,用利尿剂、血管紧张素转换酶抑制剂和钙拮抗剂治疗不增加体位性低血压的风险。Background Orthostatic hypotension may cause fall, fracture, cardiocerebrovascular events and death. Objective To determine the prevalence and risk factors of orthostatic hypotension in a community-based middle aged and old hypertensive population. Methods This cross-sectional study was conducted in 5101 hyperten- sive patients aged 40 to 75 years in 7 communities of Xinyang county. The orthostatic blood pressure was measured in supine position after resting for more than 5 minutes and at 0 and 2 rain after standing. Orthostatic hypotension was defined as 20 mmHg or greater decrease in SBP or 10 mmHg or greater decrease in DBP. Results The prevalence of orthostatic hypotension was 23.8% at either 0 or 2 min after standing（20.1% or 17.2%, respectively） in middle aged and old hypertensive patients. Orthostatic hypotension was significantly increased with age （40-49 years： 11.8%, 50-59 years： 16.1%, 60--75 years： 18.3%, P=0.004） in women. No significant difference was found between treated and untreated hypertensive patients （P〉0.05）. After adjustment for age, gender, BMI, antihypertensive treatment, logistic regression analysis showed that coronary heart disease （OR： 1.78, 95M CI： 1.30-2.48, P〈0.01）, previous stroke （OR： 1.40, 95% CI： 1. 06 -1. 90 , P=0.034）, supine blood pressure, sitting blood pressure and heart rate （OR： 0. 98, 95% CI： 0. 98-0.99, P=0. 001） were predispo- sing determinants for orthostatic hypotension. Conclusions Orthostatic hypotension is common in middle and old hypertensive patients which increased with age in women. Comorbid cardiovascular disease, but not antihypertensive treatment, may increase the risk of orthostatic hypotension.

关 键 词：原发性高血压 体位性低血压 危险因素 

分 类 号：R544.1[医药卫生—心血管疾病]