The prevalence and pathological correlates of orthostatic hypotension and its subtypes when measured using beat-to-beat technology in a sample of older adults living in the community
The prevalence and pathological correlates of orthostatic hypotension and its subtypes when measured using beat-to-beat technology in a sample of older adults living in the community
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DOI：
10.1093/ageing/aft112
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发表时间：
2013-11-01
期刊：
影响因子：
6.7
通讯作者：
Lyons, Declan
中科院分区：
文献类型：
--
作者：
Cooke, John;Carew, Sheila;Lyons, Declan
背景：逐搏技术越来越多地用于调查直立性不耐受 (OI)，但用该技术诊断的直立性低血压 (OH) 的患病率尚不清楚。目标：(i) 使用逐搏技术来定义 OH 的患病率，(ii) 调查 OH 的病理相关性，(iii) 报告体位血压反应的多样性。方法：对 65 岁以上成人的横断面研究。分析了 3 分钟抬头倾斜时的血压反应。结果：326 名参与者中，203 名（62.3%）为女性。中位年龄 (IQR) 为 73 岁 (70-78)。一百九十一 (58.6%) 符合 OH 标准（收缩压 20 毫米汞柱/舒张压 10 毫米汞柱）。女性患病率较高（女性为 60.1%，男性为 56.1%）； 47%为小动脉亚型，33%为小静脉亚型，9%为混合型，11.0%无法分类。形态学分析确定 102 名受试者为“小下降，过冲”，131 名受试者为“中度下降，恢复缓慢”，31 名受试者为“大下降，未恢复”。患有 OH 的人体重指数较低 (P = 0.02)，静息心率较高 (P = 0.005)，更有可能服用精神药物 (P = 0.02)，患有眩晕 (P = 0.004) 并报告 OI (P = 0.02)。收缩压 (SYSBP) 衰减 > 20 mmHg 的持续时间的第 95 个百分位数为 175 秒，收缩压衰减的斜率为 4.75 mmHg/s。 SYSBP 恢复百分比的第 5 个百分位数为 81.4%。结论：(i) 逐搏方法比血压测量法识别出 OH 的患病率更高，(ii) 以这种方式诊断的 OH 的病理相关性与血压测量法描述的相似，(iii) 存在多种体位性血压下降模式，可用于未来的研究来预测 OH 的不良结果。
Background: beat-to-beat technology is increasingly used for investigating orthostatic intolerance (OI) but the prevalence of orthostatic hypotension (OH) diagnosed with this technology is unclear.Objectives: (i) to use beat-to-beat technology to define the prevalence of OH, (ii) to investigate the pathological correlates of OH, (iii) to report the diversity of postural BP responses.Methods: cross-sectional study of adults >= 65 years. BP responses to a 3-min head-up tilt were analysed.Results: of 326 participants, 203(62.3%) were females. The median (IQR) age was 73 (70-78). One hundred and ninety-one (58.6%) met standard (20 mmHg systolic/10 mmHg diastolic) criteria for OH. The prevalence was higher in females (60.1% F versus 56.1% M); 47% were arteriolar subtype, 33% were venular, 9% were mixed and 11.0% could not be classified. Morphological analysis identified 102 subjects with 'small drop, overshoot', 131 with 'medium drop, slow recovery' and 31 with 'large drop, nonrecovery'. Those with OH had a lower BMI (P = 0.02), a higher resting heart rate (P = 0.005), were more likely to take a psychotropic (P = 0.02), have vertigo (P = 0.004) and report OI (P = 0.02). The 95th centile for the duration of systolic BP (SYSBP) decay > 20 mmHg was 175 s and the slope of systolic BP decay was 4.75 mmHg/s. The 5th centile for percentage recovery of SYSBP was 81.4%.Conclusion: (i) beat-to-beat methods identify a higher prevalence of OH than sphygmomanometry, (ii) the pathological correlates of OH diagnosed in this manner are similar to those described for sphygmomanometry, (iii) there is a diverse pattern of orthostatic BP decay that could be used in future research to predict adverse outcomes in OH.