老年体位性低血压与心肌梗死的关系  

The correlation between postural hypotension and myocardial infarction in the elderly population

作　　者：林仲秋[1] 潘春梅[1] 黎蔚华[1] 黄克强[1] 谢志泉[1] 

机构地区：[1]广州军区广州总医院老年科,510010

出　　处：《中华内科杂志》2012年第7期520-523,共4页Chinese Journal of Internal Medicine

基　　金：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与心肌梗死（MI）的关系。方法对广州军区离退休干部中〉65岁的1081例无MI的老年患者进行立卧位血压及心率的测量，将患者分为收缩压体位性低血压（OH—S）／H张性体位性低血压（OH-D）两部分，统计其发生率；对上述人群进行跟踪随访，以新发MI作为终点事件，分别观察OH—S／OH-D与新发MI的关系。结果人群总的体位性低血压发生率为24．5％（OH—S19．3％，OH．D17．2％），高龄老年组体位性低血压、OH—S明显高于老年组（26．1％比20．1％，P=0．045；21．0％比14．6％，P=0．018）；OH—D的发生率在两组之间差异无统计学意义；随访315d后，体位性低血压患者中的MI发生率明显高于非体位性低血压患者；OH—S和OH-D患者的MI发生率分别高于非OH-S和非OH—D患者。进一步校正年龄、卧位血压、肌酐、既往心脑血管病史后，体位性低血压（HR15．635，95％CI3．299—74．091．P=0．001）、OH—S（HR8．760。95％CI2．487—30．851，P=0．001）、OH－D（HR3．889，95％CI1．097—13．790，P=0．035）与MI的发生仍具有相关性，OH-S与OH—D相比有更大的相关性。结论收缩压及舒张压体位性低血压增加MI的发生风险。Objective To investigate the association between the systolic/diastolic orthostatic hypotension （OH-S/OH-D） and myocardial infarction （MI） in the elderly. Methods Health screening physical examination were carried in 1081 subjects without MI aged over 65 years in Guangzhou Military region. The orthostatic blood pressure and heart rate were measured in supine position after resting for more than 5 minutes and at 0 and 2 minutes after standing. All the cases were divided into systolic or diastolic group on the basis of definition of orthostatie hypotension and followed up by telephone or inpatient medical records with mean period of 315.8 days. The primary endpoint was MI occurrence. Results The prevalence of OH in this cohort was 24. 5% （OH-S/OH-D：19. 3%/17.2% ）. Significant differences in the occurrence of OH and OH-S were found in the elderly and the very elderly subjects （ ≥ 80 years） （26. 1% vs 20. 1% , P =0. 045 ; 21.0% vs 14. 6% ,P =0. 018） , while no difference was found in OH-D. The prevalence of MI in the OH positive subjects was significantly higher than that in the OH negative subjects, as well as in OH-S or OH-D group. After adjustment of age, supine blood pressure, creatinine and cerebrovascular history by logistic regression, the association was observed between MI and OH （HR 15. 635,95% CI 3. 299-74. 091, P = 0. 001 ）, OH-S（ HR 8.760,95% CI 2. 487-30. 851, P = 0. 001 ） and OH-D （ HR 3. 889,95% CI 1. 097- 13. 790, P = 0. 035 ）. Conclusion OH-S and OH-D hypotension are robust predictors for MI in the elderly.

关 键 词：老年人 体位 血压 心肌梗死 

分 类 号：R542.22[医药卫生—心血管疾病]