Hypertension:体位性低血压、心血管结局和不良事件

2020-01-28 xing.T MedSci原创

由此可见,OH与心血管疾病事件的高风险无关,并且BP治疗目标对OH与低血压和心动过缓之间的关联没有影响。即使在较低BP目标的情况下,不应将高血压治疗期间的症状性OH视为减弱降压治疗的原因。

高血压治疗中常发生体位性低血压(OH),但其对不良结局的影响尚不清楚。近日,心血管权威杂志Hypertension上发表了一篇研究文章。收缩压干预试验(SPRINT)是一项在年龄超过50岁且心血管疾病高风险成年人中进行的随机试验,这些受试者坐位收缩压(BP)为130-180 mmHg,站立时收缩压≥110 mmHg。

参与者被随机分配至收缩压治疗目标<120 mmHg或<140 mmHg组。OH的定义是坐姿站立1分钟后收缩压下降≥20mmHg或舒张压下降≥10mmHg。研究人员使用Cox模型通过评估OH与心血管疾病或不良研究结局之间的相关性。

在随访期间(中位数为3年),分配至标准BP目标组的患者中1170名(5.7%)受试者发生OH,在分配至强化BP目标组的患者中有1057名(5.0%)受试者发生OH。OH与心血管疾病事件的高风险无关(主要结果:风险比为1.06 [95%CI为0.78–1.44])。而且,OH与晕厥、电解质紊乱、伤害性跌倒或急性肾衰竭无关。OH与低血压相关的住院或急诊就诊(风险比为1.77 [95%CI为1.11-2.82])和心动过缓(风险比为1.94 [95%CI为1.13-3.15])相关,但这些关联没有因BP治疗目标不同而异。

由此可见,OH与心血管疾病事件的高风险无关,并且BP治疗目标对OH与低血压和心动过缓之间的关联没有影响。即使在较低BP目标的情况下,不应将高血压治疗期间的症状性OH视为减弱降压治疗的原因。

原始出处:

Stephen P. Juraschek.et al.Orthostatic Hypotension, Cardiovascular Outcomes, and Adverse Events Results From SPRINT.Hypertension.2020.https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.119.14309

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    2020-07-27 feather89
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    2020-01-30 天地飞扬

    学习了

    0

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    2020-01-30 1478fa69m73暂无昵称

    学习了

    0

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PLOS MED:体位性低血压会增加长期痴呆症风险

体位性低血压(OH)是短暂性脑缺血的常见原因。脑缺血与认知障碍息息相关,但是OH与认知功能下降和痴呆风险之间的联系是不确定的。 我们的目的是确定一般人群中(无痴呆症、无卒中),OH和患痴呆症风险之间的联系。 OH定义为体位变化三分钟内,收缩压下降≥20 mm Hg,或舒张压下降≥10 mm。校正年龄、性别、吸烟、饮酒、收缩压、舒张压、胆固醇/高密度脂蛋白比值、糖尿病、体重指数、使用降压

Hypertension:体位性低血压对糖尿病合并高血压患者的影响

由此可见,在2型糖尿病合并高血压的患者中,体位性低血压较为常见的,与强化或者标准的血压治疗的目标无关,但可以作为预测死亡率和心脏衰竭事件增加的指标。

J Hypertens:老年人体位性低血压与认知功能、脑损伤或脑血流特征无关!

由此可见,在老年人中,体位性低血压的存在与认知能力下降无关。此外,在潜在的脑血管机制中也没有发现差异。

Hypertension:体位性低血压心血管标志物的蛋白质组学研究!

由此可见,OH患者的蛋白质组学分析揭示了动脉粥样硬化血栓形成和炎症的生物标志。MMP-7和TIM-1循环水平与OH独立相关,可能参与心血管疾病的进展。

Plos Med:体位性低血压患者易发生老年痴呆症

由此可见,在主要是欧洲血统的人群中,OH与老年痴呆症的长期风险增加有关。