静止性低血压的时间及其与老年人跌倒的关系
Aldis H Petriceks1,2, Lawrence J Appel3,4,5, Edgar R Miller3,4,5
1Harvard Medical School, Boston, Massachusetts, USA.
Journal of the American Geriatrics Society
|September 5, 2023
概括
正静性低血压在老年人中站立后立即很常见,但更容易预测以后的跌倒风险. 评估时间对诊断这种疾病和管理跌倒风险的临床相关性产生影响.
科学领域:
- 老年学是一门学科.
- 心血管医学 心血管医学
- 临床试验 临床试验
背景情况:
- 关于在站立后评估正静性低血压的最佳时间存在不一致的证据.
- 静止性低血压 (OH) 是老年人的一个重大问题,与降落风险和症状的增加有关.
研究的目的:
- 为了确定在老年人中站立后在不同时间点发生静止性低血压的患病率.
- 评估静止性低血压,跌倒风险和相关症状在不同测量间隔之间的关联.
主要方法:
- 对"了解降落减少和维生素D的研究" (STURDY) 随机临床试验的二次分析.
- 包括70岁及以上的社区成年人,在站起来后立即和3分钟间隔测量血压 (M1-M6).
- 考克斯的比例危险模型分析了每次测量和随后的跌倒中OH之间的关系,并对24个月的随访进行了跟踪.
主要成果:
- 正静性低血压的患病率在第一个测量 (M1) 时为32%,在M5和M6.0时降至16%.
- 平均即时 (M1-3) 和延迟 (M4-6) 的OH测量预测了较高的跌倒风险 (HR分别为1.65和1.73).
- 在M5和M6的个体测量最能预测跌倒风险,而M1和M2与报告的症状最相关.
结论:
- 正静性低血压是最常见的,并在站立后不久 (1-2分钟) 出现症状.
- 然而,在4.5分钟后的评估对预测跌倒风险更有信息性.
- 临床医生在评估老年人是否有静止性低血压时,应考虑立即和延迟测量.
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