ORTHOSTATIC HYPOTENSION IN OLDER ADULTS - THE CARDIOVASCULAR HEALTH STUDY

被引:455
作者
RUTAN, GH
HERMANSON, B
BILD, DE
KITTNER, SJ
LABAW, F
TELL, GS
机构
[1] CHS COORDINATING CTR,1107 NE 45TH,ROOM 530,SEATTLE,WA 98105
[2] UNIV TENNESSEE CTR HLTH SCI,DEPT VET AFFAIRS,MEMPHIS,TN 38163
[3] UNIV TENNESSEE CTR HLTH SCI,DEPT MED,MEMPHIS,TN 38163
[4] UNIV TENNESSEE CTR HLTH SCI,DEPT PREVENT MED,MEMPHIS,TN 38163
[5] UNIV WASHINGTON,SEATTLE,WA 98195
[6] NHLBI,DIV EPIDEMIOL & CLIN APPLICAT,BETHESDA,MD 20892
[7] UNIV MARYLAND,DEPT NEUROL,BALTIMORE,MD 21201
[8] UNIV MARYLAND,DEPT EPIDEMIOL,BALTIMORE,MD 21201
[9] UNIV MARYLAND,DEPT PREVENT MED,BALTIMORE,MD 21201
[10] UNIV CALIF DAVIS,SACRAMENTO MED CTR,DEPT COMMUNITY HLTH,SACRAMENTO,CA 95817
[11] WAKE FOREST UNIV,BOWMAN GRAY SCH MED,DEPT PUBL HLTH SCI,WINSTON SALEM,NC 27103
关键词
ORTHOSTATIC HYPOTENSION; CARDIOVASCULAR DISEASE; CEREBROVASCULAR DISEASE; AGING; SYSTOLIC HYPERTENSION;
D O I
10.1161/01.HYP.19.6.508
中图分类号
R6 [外科学];
学科分类号
1002 ; 100210 ;
摘要
The purpose of the present study was to assess the prevalence of orthostatic hypotension and its associations with demographic characteristics, cardiovascular risk factors and symptomatology, prevalent cardiovascular disease, and selected clinical measurements in the Cardiovascular Health Study, a multicenter, observational, longitudinal study enrolling 5,201 men and women aged 65 years and older at initial examination. Blood pressure measurements were obtained with the subjects in a supine position and after they had been standing for 3 minutes. The prevalence of asymptomatic orthostatic hypotension, defined as 20 mm Hg or greater decrease in systolic or 10 mm Hg or greater decrease in diastolic blood pressure, was 16.2%. This prevalence increased to 18.2% when the definition also included those in whom the procedure was aborted due to dizziness upon standing. The prevalence was higher at successive ages. Orthostatic hypotension was associated significantly with difficulty walking (odds ratio, 1.23; 95% confidence interval, 1.02, 1.46), frequent falls (odds ratio, 1.52; confidence interval, 1.04, 2.22), and histories of myocardial infarction (odds ratio, 1.24; confidence interval, 1.02, 1.50) and transient ischemic attacks (odds ratio, 1.68; confidence interval, 1.12, 2.51). History of stroke, angina pectoris, and diabetes mellitus were not associated significantly with orthostatic hypotension. In addition, orthostatic hypotension was associated with isolated systolic hypertension (odds ratio, 1.35; confidence interval, 1.09, 1.68), major electrocardiographic abnormalities (odds ratio, 1.21; confidence interval, 1.03, 1.42), and the presence of carotid artery stenosis based on ultrasonography (odds ratio, 1.67; confidence interval, 1.23, 2.26). Orthostatic hypotension was negatively associated with weight. We conclude that orthostatic hypotension is common in the elderly and increases with advancing age. It is associated with cardiovascular disease, particularly those manifestations measured objectively, such as carotid stenosis. It is associated also with general neurological symptoms, but this link may not be causal. Differences in prevalence of and associations with orthostatic hypotension in the present study compared with others are largely attributed to differences in population characteristics and methodology.
引用
收藏
页码:508 / 519
页数:12
相关论文
共 37 条
[1]   DRUG-RELATED SYNCOPE [J].
DAVIDSON, E ;
FUCHS, J ;
ROTENBERG, Z ;
WEINBERGER, I ;
AGMON, J .
CLINICAL CARDIOLOGY, 1989, 12 (10) :577-580
[2]   THE ASSOCIATION OF POSTURAL CHANGES IN SYSTOLIC BLOOD-PRESSURE AND MORTALITY IN PERSONS WITH HYPERTENSION - THE HYPERTENSION DETECTION AND FOLLOW-UP PROGRAM EXPERIENCE [J].
DAVIS, BR ;
LANGFORD, HG ;
BLAUFOX, MD ;
CURB, JD ;
POLK, BF ;
SHULMAN, NB .
CIRCULATION, 1987, 75 (02) :340-346
[3]  
DEBIASE L, 1988, J HYPERTENS, V6, pS63
[4]   ORTHOSTATIC HYPOTENSION AS A RISK FACTOR FOR SYMPTOMATIC OCCLUSIVE CEREBROVASCULAR-DISEASE [J].
DOBKIN, BH .
NEUROLOGY, 1989, 39 (01) :30-34
[5]   LONGITUDINALLY MEASURED BLOOD-PRESSURE, ANTIHYPERTENSIVE MEDICATION USE, AND COGNITIVE PERFORMANCE - THE FRAMINGHAM-STUDY [J].
FARMER, ME ;
KITTNER, SJ ;
ABBOTT, RD ;
WOLZ, MM ;
WOLF, PA ;
WHITE, LR .
JOURNAL OF CLINICAL EPIDEMIOLOGY, 1990, 43 (05) :475-480
[6]   BLOOD-PRESSURE AND COGNITIVE PERFORMANCE - THE FRAMINGHAM-STUDY [J].
FARMER, ME ;
WHITE, LR ;
ABBOTT, RD ;
KITTNER, SJ ;
KAPLAN, E ;
WOLZ, MM ;
BRODY, JA ;
WOLF, PA .
AMERICAN JOURNAL OF EPIDEMIOLOGY, 1987, 126 (06) :1103-1114
[7]   MINI-MENTAL STATE - PRACTICAL METHOD FOR GRADING COGNITIVE STATE OF PATIENTS FOR CLINICIAN [J].
FOLSTEIN, MF ;
FOLSTEIN, SE ;
MCHUGH, PR .
JOURNAL OF PSYCHIATRIC RESEARCH, 1975, 12 (03) :189-198
[8]  
Fried Linda P., 1991, Annals of Epidemiology, V1, P263
[9]  
Frohlich ED, 1988, HYPERTENSION, V11, p209A
[10]  
HARRIS T, 1986, GERONTOLOGIST, V26, pA59