中老年高血压患者体位性高血压和体位性低血压与靶器官损害关系分析  

Association of orthostatic hypertension and hypotension with target organ damage in middle and old-aged hypertensive patients

作　　者：樊晓寒[1] 孙凯[1] 周宪梁[1] 张慧敏[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中心,北京 100037

出　　处：《中华医学杂志》2011年第4期220-224,共5页National Medical Journal of China

基　　金：国家重点基础研究发展计划“973”项目（2006CB503805）;国家自然科学基金（30871054）

摘　　要：目的 探讨中国中老年高血压患者体位性高血压和体位性低血压与靶器官损害的关系。方法通过阶段性随机整群抽样人选河南信阳7个社区4711例40～75岁高血压患者，进行问卷、生化指标、心脏超声、踝臂指数、卧立位血压等检查。体位性高血压定义为直立位后30S和2min收缩压平均值升高≥20mm Hg，体位性低血压定义为直立位后30S和（或）2min收缩压下降或（及）舒张压下降≥20／10mmHg，无上述两种异常者定义为体位性血压正常。结果高血压患者中体位性高血压发生率16．3％，体位性低血压发生率23．8％。外周血管病在体位性高血压（10．1％）和低血压（10．7％）患者中均显著高于体位性血压正常者（7．4％）（均P〈0．05）。体位性低血压患者与体位血压正常者比较左室肥厚（53．0％比43．2％，P〈0．001）和肾小球滤过率降低（38．6％比34．4％，P〈0．05）发生率更高。调整年龄、性别、BMI等其他危险因素后，体位性高血压（OR1．39，95％CI1．05～1．84）和低血压（OR1．45，95％CI1．13～1．86）仍显著增加外周血管病危险，体位性低血压显著增加左室肥厚危险（OR1．46，95％CI1．11～1．84），而体位性低血压与肾小球滤过率降低的关系兀统计学意义。在女性高血压患者中，体位性收缩压变化五分位组预测左室肥厚的OR值呈J形曲线。在未治疗高血压患者中，体位性收缩压变化五分位组预测外周血管病的OR值也呈J形曲线分布。结论中老年高血压患者合并体位性高血压和体位性低血压发生高血压靶器官损害的危险较高。Objective To investigate the association of orthostatic hypertension and hypotension with hypertensive target organ damage in middle and old-aged hypertensive patients. Methods This crosssection study was conducted in 4711 hypertensive patients aged 40 - 75 years old in 7 communities of Xinyang County, Henan Province by a multistage cluster sampling method. All patients received a standardized questionnaire, physical and biochemical examinations, echocardiography, ankle-brachial blood pressure index and orthostatic blood pressure measurement. Orthostatic hypertension was defined as an elevation of systolic blood pressure by 20 mm Hg or more while orthostatic hypotension as a drop of blood pressure by 20/10 mm Hg or more. When an upright posture was assumed. Others not belonging to these two conditions were classified into orthostatic normotension. Results The prevalence of orthostatic hypertension and hypotension was 16. 3% and 23.8% in hypertensive patients, Peripheral artery disease was significantly more frequent in hypertensives with orthostatic hypertension （ 10. 1% ） or hypotension （ 10. 7% ） than those with orthostatic normotensives （7.4%） （ both P 〈 0. 05 ）. Patients with orthostatie hypotension had more common left ventricular hypertrophy （53.0% vs 43.2% , P 〈 0. 001 ） and a decreased estimated glomerular filtration rate （38.6% vs 34.4% , P 〈0. 05） than did those with orthostatic noimotension. After controlling for age, gender, body mass index and other confounders, orthostatic hypertension was positively associatedwith peripheral arterial disease （OR 1.39, 95% CI 1.05 -1.84） while orthostatic hypotension was significantly associated with peripheral arterial disease （OR 1.45, 95% CI 1.13 -1.86） and left ventricular hypertrophy （OR 1.46, 95% CI 1.11 -1.84 ）. But no independent association was found between orthostatic hypertenson or hypotension and a decreased estimated glomerular filtration rate in hypertensive patients. The adjusted odds ratios （OR） for left

关 键 词：高血压 低血压 直立性 高血压 直立性 靶器官损害 

分 类 号：R544.1[医药卫生—心血管疾病]