Association of Supine Hypertension Versus Standing Hypotension With Adverse Events Among Middle-Aged Adults.
Association of Supine Hypertension Versus Standing Hypotension With Adverse Events Among Middle-Aged Adults.
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卧位高血压与立位低血压与中年成人不良事件的关系。
DOI：
10.1161/hypertensionaha.123.21215
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Juraschek,StephenP
中科院分区：
文献类型：
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作者：
Earle,WilliamB;Kondo,JordanK;Kendrick,KarlaN;Turkson-Ocran,Ruth-Alma;Ngo,Long;Cluett,JenniferL;Mukamal,KennethJ;DayaMalek,Natalie;Selvin,Elizabeth;Lutsey,PamelaL;Coresh,Josef;Juraschek,StephenP
背景立位性低血压(OH)的治疗优先于预防立位性低血压，有时以仰卧位高血压为代价。目前尚不清楚仰卧位高血压是否与立位降压相关的不良结局有关。目的比较卧位高血压和立位低血压在有和没有OH的中年人中的长期临床后果。方法：ARIC研究(社区动脉粥样硬化风险)测量了1987年至期间45岁至，无神经源性OH的成年人的仰卧位和立位血压(BP)。我们将OH定义为收缩压≥20 mm Hg或舒张压≥10 mm Hg的位置下降，仰卧位高血压定义为仰卧位BP≥140/≥90 mm Hg，站立低血压定义为立位BP≤105/≤65 mm Hg。对参与者进行了长达30年的跟踪调查。我们使用COX回归模型来检验与心血管疾病事件、全因死亡率、跌倒和晕厥的关系。结果12名 489名参与者(女性55%，黑人26%，平均年龄54岁，SD6)，4.4%有OH。在无OH组(N=11 943)中，19%有仰卧位高血压，21%有立位性低血压；而在OH组(N=546)中，58%有仰卧位高血压，38%有立位低血压。与结果的相关性并不因羟基磷灰石状态而异(P-交互作用&>0.25)。仰卧位高血压与心力衰竭(危险比，1.83[95%CI，1.68-1.99])、跌倒(危险比，1.12[95%CI，1.02-1.22])和全因死亡率(危险比，1.45[95%CI，1.37-1.54])有关，而立位低血压仅与死亡率(危险比，1.06[95%CI，1.00-1.14])显著相关。这挑战了传统的OH管理，它优先于立位低血压而不是仰卧位高血压。
BACKGROUNDManagement of orthostatic hypotension (OH) prioritizes prevention of standing hypotension, sometimes at the expense of supine hypertension. It is unclear whether supine hypertension is associated with adverse outcomes relative to standing hypotension.OBJECTIVESTo compare the long-term clinical consequences of supine hypertension and standing hypotension among middle-aged adults with and without OH.METHODSThe ARIC study (Atherosclerosis Risk in Communities) measured supine and standing blood pressure (BP) in adults aged 45 to 64 years, without neurogenic OH, between 1987 and 1989. We defined OH as a positional drop in systolic BP ≥20 mm Hg or diastolic BP ≥10 mm Hg, supine hypertension as supine BP≥140/≥90 mm Hg, and standing hypotension as standing BP≤105/≤65 mm Hg. Participants were followed for >30 years. We used Cox regression models to examine associations with cardiovascular disease events, all-cause mortality, falls, and syncope.RESULTSOf 12 489 participants (55% female, 26% Black, mean age 54 years, SD 6), 4.4% had OH. Among those without OH (N=11 943), 19% had supine hypertension and 21% had standing hypotension, while among those with OH (N=546), 58% had supine hypertension and 38% had standing hypotension. Associations with outcomes did not differ by OH status (P-interactions >0.25). Supine hypertension was associated with heart failure (hazard ratio, 1.83 [95% CI, 1.68–1.99]), falls (hazard ratio, 1.12 [95% CI, 1.02–1.22]), and all-cause mortality (hazard ratio, 1.45 [95% CI, 1.37–1.54]), while standing hypotension was only significantly associated with mortality (hazard ratio, 1.06 [95% CI, 1.00–1.14]).CONCLUSIONSSupine hypertension was associated with higher risk of adverse events than standing hypotension, regardless of OH status. This challenges conventional OH management, which prioritizes standing hypotension over supine hypertension.