| BackgroundWith the intensification of social aging,the prevalence of hypertension in the elderly is increasing,and its special type of hypertension has its own characteristics: the main systolic blood pressure,blood pressure fluctuation range,prone to orthostatic hypotension and so on.The occurrence of orthostatic hypotension(OH)greatly increases cardiovascular and cerebrovascular mortality and all-cause mortality.But for elderly patients with hypertension combined with OH patients in the antihypertensive treatment is the benefit of elderly hypertension and OH are linked to the impact of the target organ,how old age hypertension combined with OH blood pressure control target range is how much Best benefit risk ratio ? The current domestic and foreign literature on this research data is very little,no relevant information for reference.This study was to investigate the prevalence of hypertension and the prevalence of hypertension,the factors,cardiovascular and cerebrovascular risk in elderly patients,and to explore the optimal blood pressure control range for elderly hypertensive patients with OH and to provide evidence-based reference for clinical management of such patients,Thereby reducing the associated cardiovascular disease and mortality,reducing rehospitalization,and reducing the social burden.Objective1.To study the evolution and related factors of the elderly hypertension patients with OH.2.Analysis of elderly hypertensive and OH patients with cardiovascular and cerebrovascular risk.3.To explore the appropriate blood pressure control target for elderly hypertensive and OH patients.Object and Method1.Method: From 2010 to 2016,data were collected from regular hypertensive patients who met the conditions of inclusion in the retired dry retired population aged ?65 years in the Guangzhou Military Region.The data were collected by regular questionnaires and follow-up.According to the needs of design investigations:” elderly cardiovascular disease and risk factor survey” and “elderly hypertension with orthostatic hypotension follow-up table” to extract data,including general information and physical,laboratory examination results.Medical records into the group in 2010 January 1,up to 2017 December 31,the end of the,mainly follow-up method for according to medical follow-up data,necessary access to retired cadres health information and telephone follow-up etc.2.Blood pressure grouping: Measured in accordance with the standard blood pressure measurement,measured twice after taking the average.According to the data collected in 2010 and the results of the previous study,the subjects were divided into four target blood pressure groups: the first group of target blood pressure: systolic blood pressure <130mm Hg;the second group of target blood pressure: systolic blood pressure 130 ~ 139mmHg;Target blood pressure: systolic blood pressure 140 ~ 149mmHg;the fourth group of target blood pressure: systolic blood pressure ? 150 mmHg.3.Age group: To study whether the hypertensive population was combined with OH for grouping,divided into OH group and non-OH group.4.Statistical Methods: We use SPSS 20.0 software for statistical analysis.Metrological data are expressed as mean ± standard deviation.Comparison of two sets of measurement data with t test,multiple sets of measurement data using variance analysis.The rate of comparison is applied by chi-square test.The risk factors for the combination of OH in elderly hypertensive patients were analyzed by univariate and multivariate logistic regression analysis.There was significant difference between the two groups(P <0.05).The blood pressure levels were graded,and the incidence of events was calculated based on the number of events at each level.The ?2 test was used.Survival analysis The Cox proportional hazards regression model was used to compare the risk of all-cause death,cardiovascular and cerebrovascular events among groups.The correlation between cardiovascular and cerebrovascular risk survival curves of patients with hypertension was analyzed by single factor and multivariate Cox regression.The test standard was statistically significant with P <0.05.Results1.The baseline data of the study population were different from those after follow-upCompared with the non-OH group,the age of the two groups showed that there was a significant difference in age between the two groups.The higher the proportion of OH in the 80-year-old hypertensive patients.There were significant differences in age,supine blood pressure,standing blood pressure,pulse pressure,creatinine,combined stroke history,myocardial infarction history and heart failure history among the non-OH groups(P <0.05).Compared with the comparison in 2010,found that age changes in the statistics.2.The elderly hypertensive with OH patients related factorsThe results showed that SBP,lying position DBP,standing position 0minSBP,standing position 0minDBP,orthostatic 2minSBP,standing 2minDBP,pulse pressure,stroke were found in the risk factors of elderly patients with hypertension combined with OH.History,history of coronary heart disease,heart failure history and hypertension and OH patients(P <0.05).All the significant variables were included in the multivariate logistic regression analysis,and the results showed that systolic systolic pressure was a risk factor for elderly patients with hypertension combined with OH.3.Study the cardiovascular and cerebrovascular risks in the population3.1 OH group and non-OH group of clinical events: the study were followed up for 6 years,the number of deaths during follow-up 317 cases,of which OH group all the number of deaths due to 132 cases,51 cases of cardiovascular death,cerebrovascular death in 18 cases,84 cases of vascular events,65 cases of cerebrovascular events;185 cases of non-OH group,58 cases of cardiovascular death,23 cases of cerebrovascular death,130 cases of cardiovascular events,cerebrovascular events in 66 cases.There was significant difference between the two groups(P <0.05).3.2 Analysis of cardiovascular and cerebrovascular risk ratios between OH group and non-OH group by Cox proportional hazards regression model: All-cause death(RR,2.168;95% CI,1.733-2.711;P <0.001)in elderly patients with hypertension and OH,Cardiovascular death(RR,1.573;95% CI,1.070 ~ 2.312;P <0.001),Cerebral vascular events(RR,1.561;95% CI,1.146 ~ 2.126;P = 0.005),cardiovascular events(RR,1.017;95% CI,1.015 ~ 1.127;P <0.001)95% CI,1.383 to 2.040;P <0.001).3.3 The risk-survival curve of cardiovascular and cerebrovascular events in OH group and non-OH group: The estimated results of all-cause death,cardiovascular and cerebrovascular death and cardiovascular and cerebrovascular events in Cox regression survival group were statistically significant(P <0.05).4.Elderly hypertensive patients with OH optimal blood pressure range4.1Baseline data analysis between different systolic blood pressure groups: The results showed that SBP different groups were 0minSBP(OH-S0),0minDBP(OH-D0),established 2minSBP(OH-S2),established 2minDBP(OH-D2)(? OH-S2),PP were significantly different(P <0.05).There was significant difference between the two groups(P <0.05).4.2 Comparison of clinical events between different systolic blood pressure groups: According to the different levels of systolic blood pressure divided into four groups,including <130mmHg group of 53 cases,130 ~ 139 mmHg group 60 cases,140 ~ 149 mmHg group 70 cases,? 150 mmHg group 67 cases.The incidence of cardiovascular and cerebrovascular events and cerebrovascular events was the lowest in the 130 ~ 139 mmHg group compared with the other groups(P <0.05).4.3 Analysis of cardiovascular and cerebrovascular risk ratios between OH group and non-OH group by Cox proportional hazards regression model:The highest incidence of clinical events in the group(the worst effect,? 150 mmHg group)as a reference group,the results found 130 ~ 139 mmHg group due to death,cardiovascular and cerebrovascular death compared with other groups no significant statistical difference,and ? 150 MmHg group,cardiovascular events,cerebrovascular events occurred low risk,the difference was statistically significant(P <0.05).4.4There were significant differences in the risk of cardiovascular and cerebrovascular events between the four groups(P <0.05).There was no correlation between vascular death.Conclusion:1.Orthostatic hypotension is increasing with ? 80 years old elderly patients with hypertension is more common.2.In elderly hypertensive patients,patients with OH showed worse cardiovascular and cerebrovascular prognosis,increased all-cause death and cardiovascular and cerebrovascular risk.3.The elderly hypertensive and OH patients with appropriate systolic blood pressure control range of 130 ~ 139 mmHg. |
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