Standing Blood Pressure and Risk of Falls, Syncope, Coronary Heart Disease, and Mortality.
Standing Blood Pressure and Risk of Falls, Syncope, Coronary Heart Disease, and Mortality.
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站立血压与跌倒、晕厥、冠心病和死亡的风险。
DOI：
10.1093/ajh/hpad064
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发表时间：
2023
影响因子：
3.2
通讯作者：
Juraschek,StephenP
中科院分区：
文献类型：
--
作者：
Kondo,JordanK;Earle,WilliamB;Turkson-Ocran,Ruth-AlmaN;Ngo,LongH;Cluett,JenniferL;Lipsitz,LewisA;Daya,NatalieR;Selvin,Elizabeth;Lutsey,PamelaL;Coresh,Josef;Windham,BeverlyGwen;Kendrick,KarlaN;Juraschek,StephenP
AHA指南警告在低站立位收缩压（SBP）<110 mm Hg的情况下不要使用降压治疗，因为其益处尚不清楚。METHODS社区动脉粥样硬化风险（ARIC）研究测量了1987年至1989年45-64岁成人的仰卧位和站立位SBP。 我们使用考克斯回归来评估低站立位SBP（<110 mm Hg）与福尔斯、晕厥、冠心病（CHD）和死亡率风险的相关性，直至2019年12月31日。通过住院和门诊索赔确定福尔斯和晕厥;裁定CHD事件。在12,467名成年人中，平均随访时间为24年（平均年龄为54.1 ± 5.8岁，55%为女性，26%为黑人），其中3,000人（24%）的站立位SBP <110 mm Hg。 与站立位SBP ≥ 110 mm Hg相比，站立位SBP <110 mm Hg与福尔斯或晕厥无显著相关性，但与CHD事件和死亡率较低的风险相关，HR分别为1.02（95% CI 0.94，1.11）、1.02（0.93，1.11）、0.88（0.80，0.97）和0.91（0.86，0.97）。 按高血压分期、10年ASCVD风险、年龄和性别分层时，无临床意义的差异。CONCLUSIONSSIn this community-based population，低站立位SBP很常见，与福尔斯或晕厥无显著相关性，但与较低的CHD风险和死亡率相关。这些发现不支持将低站立位血压作为不良事件的风险因素进行筛查。
BACKGROUNDACC/AHA guidelines caution against the use of antihypertensive therapy in the setting of low standing systolic BP (SBP) < 110 mm Hg due to unclear benefits.METHODSThe Atherosclerosis Risk in Communities (ARIC) Study measured supine and standing SBP in adults aged 45–64 years between 1987 and 1989. We used Cox regression to evaluate the associations of low standing SBP (<110 mm Hg) with risk of falls, syncope, coronary heart disease (CHD), and mortality through December 31, 2019. Falls and syncope were ascertained by hospitalization and outpatient claims; CHD events were adjudicated. Associations were examined overall and in strata of hypertension stage, 10-year atherosclerotic cardiovascular disease (ASCVD) risk, age, and sex.RESULTSAmong 12,467 adults followed a median of 24 years (mean age at enrollment 54.1 ± 5.8 years, 55% women, 26% Black adults), 3,000 (24%) had a standing SBP < 110 mm Hg. A standing SBP < 110 mm Hg compared to standing SBP ≥ 110 mm Hg was not significantly associated with falls or syncope, and was associated with a lower risk of CHD events and mortality with HRs of 1.02 (95% CI 0.94, 1.11), 1.02 (0.93, 1.11), 0.88 (0.80, 0.97), and 0.91 (0.86, 0.97), respectively. There were no clinically meaningful differences when stratified by hypertension stage, 10-year ASCVD risk, age, and sex.CONCLUSIONSIn this community-based population, low standing SBP was common and not significantly associated with falls or syncope, but was associated with a lower risk of CHD and mortality. These findings do not support screening for low standing BP as a risk factor for adverse events.