The association between orthostatic blood pressure changes and subclinical target organ damage in subjects over 60 years old

Hong-Jie CHI; Hai-Jun FENG; Xiao-Jiao CHEN; Xiao-Tao ZHAO; En-Xiang ZHANG; Yi-Fan FAN; Xian-Chen MENG; Jiu-Chang ZHONG; Shou-Ling WU; Jun CAI

doi:10.11909/j.issn.1671-5411.2019.05.006

摘要：Background Although recent studies have indicated that both orthostatic hypotension and orthostatic hypertension independently predict cardiovascular events,the underlying mechanisms are still controversial.The aim of the study was to investigate the relationships between orthostatic changes and organ damage in subjects over 60 years old.Methods This is a prospective observational cohort study.One thousand nine hundred and ninety-seven subjects over 60 years old were enrolled.Participants were grouped according to whether they had a drop ≥ 20 mmHg in systolic or ≥ 10 mmHg in diastolic BP (orthostatic hypotension),an increase in mean orthostatic systolic blood pressure ≥ 20 mm Hg (orthostatic hypertension),or normal changes within 3 min of orthostatism.Multiple regression modeling was used to investigate the relationship between orthostatic hypotension,orthostatic hypertension and subclinical organ damage with adjustment for confounders.Results Orthostatic hypotension and orthostatic hypertension were found in 461 (23.1％) and 189 (9.5％) participants,respectively.Measurement of carotid intima-media thickness (IMT),brachial-ankle pulse wave velocity (baPWV),clearance of creatinine,and microalbuminuria were associated with orthostatic hypotension;measurement of IMT and baPWV were associated with orthostatic hypertension in a cruse model.After adjustment,IMT [odds ratio (OR),95％ confidence interval (CI) per one-SD increment:1.385,1.052-1.823;P =0.02],baPWV (OR =1.627,95％ CI:1.041-2.544;P =0.033) and microalbuminuria (OR =1.401,95％ CI:1.002-1.958;P =0.049) were still associated with orthostatic hypotension,while orthostatic hypertension was only associated with IMT (OR =1.730,95％ CI:1.143-2.618;P =0.009).Conclusions Orthostatic hypotension seems to be independently correlated with increased carotid atherosclerosis,arterial stiffness and renal damage in subjects over 60 years old.Orthostatic hypertension correlates with carotid atherosclerosis only.