老年体位性低血压与心血管疾病风险的关系  

Correlation between orthostatic hypotension and cardiovascular risks in elderly population

作　　者：林仲秋[1] 谢志泉[1] 吴自强[1] 冯国飞[1] 潘春梅[1] 王银玲[1] 王晓会[1] 许文平[1] 

机构地区：[1]广州军区广州总医院老年心血管病科干部病房四科,510010

出　　处：《中华医学杂志》2011年第36期2530-2533,共4页National Medical Journal of China

基　　金：基金项目：广东省2009科技计划项目（20098030801279）;广东省科技计划重点项目（2010803150015）

摘　　要：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3min内收缩压下降≥20mmHg和（或）舒张压下降≥10nmHg；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的跟踪随访。OH发生率为25．6％（301例）；OH患者的全因再人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％C1：1．184～3．802）、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。Objective To investigate the correlation between orthostatic hypotension and cardiovascular risks and hospitalization rate in the elders. Methods A 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 rain 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. Results The 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% C1 （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.

关 键 词：老年人 低血压 直立性 心血管疾病 住院率 

分 类 号：R54[医药卫生—心血管疾病]