作者：张艳1，王张锋2，姚涛3

单位：

1.063000河北省唐山市妇幼保健院内科　2.063000河北省唐山市，开滦总医院耳鼻喉科3.063000河北省唐山市，唐山南湖医院高血压精准诊疗中心

Units：

1.Department of Internal Medicine, Tangshan Maternal and Child Health Hospital, Tangshan 063000, China2.Department of Otorhinolaryngology, Kailuan General Hospital, Tangshan 063000, China3.Department of Accurate Diagnosis and Treatment Center for Hypertension, Tangshan Nanhu Hospital, Tangshan 063000,China

关键词：

低血压；直立性低血压；老年人；杓型血压；非杓型血压；反杓型血压；昼夜节律

Keywords：

Hypotension; Orthostatic hypotension; Aged; Dipper blood pressure; Non-dipper blood pressure;Reverse-dipper blood pressure; Circadian rhythm

CLC：

DOI：

10.12114/j.issn.1008-5971.2022.00.193

Funds：

河北省医学科学研究重点课题计划项目（20171450）

摘要：

目的　探讨老年直立性低血压（OH）检出率及其影响因素。方法　从开滦体检数据库中整群抽取2010—2011年在开滦总医院、林西医院和赵各庄医院参加健康体检的年龄≥60岁的人群共12 257例，按照25%的比例随机抽取3 064例，2012年5月至2014年12月对符合纳入与排除标准的2 464例受试者行资料收集、24 h动态血压监测、卧位和直立位血压测量。根据是否发生OH将其分为OH组和非OH组，比较两组临床资料及24 h动态血压监测结果，不同年龄段〔分为60~64岁（726例）、65~69岁（325例）、70~74岁（337例）、≥75岁（204例）〕受试者OH检出率，采用多因素Logistic回归分析探讨老年OH影响因素。结果　2 464例受试者中，24 h动态血压监测、卧位和直立位血压测量数据合格者1 738例，其中体位性高血压146例，最后1 592例纳入统计分析。1 592例受试者中，OH检出率为24.1%（384/1 592），男性OH检出率为24.0%（255/1 061），女性OH检出率为24.3%（129/531）；单纯收缩期OH 175例（11.0%），单纯舒张期OH 122例（7.7%），双期OH 87例（5.5%）。OH组年龄、有糖尿病史者所占比例、卧位收缩压、卧位舒张压高于非OH组，体育锻炼者所占比例低于非OH组（P ＜0.05）。≥75岁受试者OH检出率高于60~64岁受试者，70~74、≥75岁受试者单纯收缩期OH检出率高于60~64岁受试者，≥75岁受试者单纯收缩期OH检出率高于65~69岁受试者（P ＜0.05）。OH组24 h平均收缩压、日间平均收缩压、夜间平均收缩压高于非OH组（P ＜0.05）；两组血压昼夜节律比较，差异有统计学意义（P ＜0.05）。多因素Logistic回归分析结果显示，年龄、体育锻炼、卧位收缩压、卧位舒张压、血压昼夜节律是老年OH的影响因素（P ＜0.05）。结论　老年OH检出率为24.1%，其中单纯收缩期OH、单纯舒张期OH、双期OH的检出率分别为11.0%、7.7%、5.5%；高龄、缺乏体育锻炼、卧位收缩压≥140mm Hg、卧位舒张压≥90 mm Hg、反杓型血压是老年OH的危险因素。

Abstract：

Objective　To explore the prevalence and influencing factors of orthostatic hypotension (OH) in the elderlypopulation. Methods　A total of 12 257 subjects aged over 60 who participated in physical examination in Kailuan GeneralHospital, Linxi Hospital and Zhao Gezhuang Hospital from 2010 to 2011 were selected from Kailuan physical examinationdatabase, and 3 064 subjects were randomly selected according to the 25% proportion, 2 464 subjects who met the inclusion andexclusion criteria performed data collection, 24-hour ambulatory and supine-standing blood pressure monitoring from May 2012 toDecember 2014. The subjects were divided into OH group and non OH group according to the occurrence of OH, the clinical dataand 24 h ambulatory blood pressure monitoring results of the two groups were compared. The detection rates of OH in differentage subjects [60-64 years old (n=726) , 65-69 years old (n=325) , 70-74 years old (n=337) and ≥ 75 years old (n=204) ] werecompared, and the influencing factors for OH in the elderly population were analyzed by multivariate Logistic regression analysis.Results　Among the 2 464 subjects, 1 738 subjects were eligible for 24-hour ambulatory and supine-standing blood pressuremonitoring data, including 146 subjects with postural hypertension, and 1 592 subjects were included in the statistical analysis.Among 1 592 subjects, the detection rate of OH was 24.1% (384/1 592) , with 24.0% (255/1 061) in males and 24.3% (129/531) infemales. Among whom 175 (11.0%) had isolated systolic OH, 122 (7.7%) had isolated diastolic OH, and 87 (5.5%) had systolicdiastolicOH. The age, proportion of patients with diabetes history, supine systolic blood pressure and supine diastolic bloodpressure in OH group were higher than those in non OH group, and the proportion of patients with physical exercise was lowerthan that in non OH group (P < 0.05) . The detection rate of OH in patients with ≥ 75 years old was higher than that in patientswith 60-64 years old, detection rate of isolated systolic OH in patients with 70-74 years old and ≥ 75 years old was higher thanthat in patients with 60-64 years old, and detection rate of isolated systolic OH in patients with ≥ 75 years old was higher thanthat in patients with 65-69 years old (P < 0.05) . The 24-hour mean systolic blood pressure, daytime mean systolic blood pressureand nighttime mean systolic blood pressure in the OH group were higher than those in the non OH group (P < 0.05) . There wassignificant difference in the circadian blood pressure rhythm between the two groups (P < 0.05) . Multivariate Logistic regressionanalysis showed that age, physical exercise, supine systolic blood pressure, supine diastolic blood pressure and circadian bloodpressure rhythm were the influence factors for OH in the elderly population (P < 0.05) . Conclusion　The detection rate of OHin the elderly is 24.1%, and the detection rate of isolated systolic, isolated diastolic, and systolic-diastolic OH are 11.0%, 7.7%and 5.5%, respectively. Advanced age, no physical exercise, supine systolic blood pressure ≥ 140 mm Hg, supine diastolic bloodpressure ≥ 90 mm Hg, reverse-dipper blood pressure are the risk factors for OH in the elderly population.

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