直立性低血压对老年人群全因死亡的影响

Effect of orthostatic hypotension on all-cause death in the elderly

目的探讨直立性低血压(orthostatic hypotension,OH)对老年人群全因死亡风险的影响。方法采用回顾性队列研究方法,以参加2010~2011年在开滦集团健康体检并接受卧立位血压测量的老年人群作为观察对象,进行统一问卷调查、血液生化检验,以2020年12月31日随访结束全因死亡为终点事件。依据卧立位血压变化值,将其分为直立性低血压组(orthostatic hypotension positive,OHP)和非直立性低血压组(orthostatic hypotension negative,OHN)。采用Log-rank检验比较OHP组和OHN组之间累积死亡率的差异;采用多因素Cox比例风险模型分析OH对老年人群全因死亡风险的影响。结果纳入符合标准的研究对象2539例,随访时间的中位数(四分位间距)为9.93(9.45~10.01)年,共发现全因死亡事件288例,Log-Rank检验结果显示,OHP组的累积死亡率明显高于OHN组(χ^(2)=7.18,P=0.01)。在Cox比例风险模型中校正年龄、性别等混杂因素后,与OHN组相比,OHP组发生全因死亡的风险比(HR)95%CI为1.35(1.04~1.75)。结论OH是老年人群发生全因死亡事件的危险因素。

Objective To explore the effect of orthostatic hypotension(OH)on the risk of all-cause death in the aged population.Methods A retrospective cohort study was conducted in the Kailuan study cohort from 2010 to 2011.The questionnaire survey and blood biochemical test were carried out.All-cause death was regarded as the end event after the follow-up end on December 31,2020.According to the change of blood pressure in the recumbent position,the elderly were divided into orthostatic hypotension positive group(OHP)and orthostatic hypotension negative group(OHN).Log-Rank test was used to compare the differences of cumulative mortality between the two groups.The effect of OH on the risk of all-cause death in the elderly population was analyzed by multivariate Cox proportional risk model.Results A total of 2539 subjects were enrolled with a median follow-up time of 9.93(9.45-10.01)years,and 288 patients with all-cause death were found.Log-Rank results showed that the cumulative mortality of OHP group was significantly higher than that of OHN group(χ^(2)=7.18,P=0.01).After adjusting for confounding factors such as age and sex in the Cox proportional risk model,the Hazardratio(HR)for all-cause death in the OHP group had 95%CI 1.35(1.04-1.75)compared with the OHN group.Conclusions OH is a risk factor for all-cause death in the elderly.