高龄老年餐后低血压的临床特点及防治策略的研究

Clinical characteristics of postprandial hypotension in very old patients and its diagnosis and treatment strategies

目的探讨高龄老年餐后低血压(PPH)的临床特点及相关因素,为临床防治提供理论依据。方法选择行24h动态血压监测的老年患者349例,按年龄分为普通老年组163例(65～79岁),高龄老年组186例(≥80岁);普通老年组高血压115例,非高血压48例,高龄老年组高血压154例,非高血压32例。每隔15min记录1次餐后血压变化,同时记录饮食、身高、体重、基础疾病及服用药物等资料。结果 349例患者PPH总检出率为59.3%,早餐和中餐PPH检出率明显高于晚餐(33.8%和32.1%vs 21.5%,P<0.05);高龄老年组PPH检出率明显高于普通老年组(63.4%vs 54.6%,P<0.05)。高血压患者PPH检出率明显高于非高血压患者(65.1%vs 40.0%,P<0.01)。年龄、高血压、降压药物与PPH检出率呈正相关(P<0.05)。PPH多于餐后15～30min血压开始下降,30～60min下降至PPH诊断标准,PPH持续时间30～120min,下降幅度20～40mm Hg(1mm Hg=0.133kPa)。结论老年人进餐后血压呈下降趋势,以早餐后检出率最高。患高血压及服用降压药物会增加PPH检出率。高龄老年PPH发生率明显高于普通老年者,餐后血压下降幅度亦高于普通老年,应加强预防和干预。

Objective To provide the theoretical evidence for the prevention and treatment of post- prandial hypotension（PPH） by studying its clinical characteristics and relative factors in very old patients. Methods Three hundred and forty-nine PPH patients undergoing 24 h ambulatory blood pressure monitoring were divided into 65-79 years old group（n=163,including 115 with hypertension and 48 without hypertension） and ≥80 years old group（n= 186,including 154 with hypertension and 32 without hypertension） according to their age. Their postprandial blood pressures were measured every 15 min and their basic clinical data were recorded. Results The detection rate of PPH in the 349 patients was 59.3%,which was significantly higher after breakfast and lunch than after supper（33.8% and 32.1% vs 21.5% ,P〈0. 05）. The detection rate of PPH was significantly higher in ≥80 years old group than in 65-79 years old group and in hypertensive patients than in non-hypertensive patients（P〈0.05, P〈0.01）. Age, hypertension and anti-hypertension drugs were positively correlated with PPH （P〈 0. 05）. PPH usually began to decrease 15-30 min after meal and reduced to its diagnostic criteria 30-60 min after meal. The persistent time of PPH was 30-120 min with a declining amplitude of 20-40 mm Hg. Conclusion Blood pressure tends to decrease after meal in elderly patients. The detection rate of PPH is the highest after breakfast. Hypertension and use of anti-hypertension drugs increase the detection rate of PPH. The incidence of PPH and the declining amplitude of blood pressure after meal are higher in very old patients than in common old patients, and should thus be prevented and treated.