美国贝斯以色列女执事医疗中心William C Cushman研究组报道了强化血压治疗对直立性高血压的影响。这一研究成果发表在2025年3月25日出版的国际学术期刊《英国医学杂志》上。

目的:探讨强化降压治疗对直立性高血压的影响。

设计:系统评价和个体参与者数据荟萃分析。数据来源截至2023年11月13日的MEDLINE、Embase和Cochrane CENTRAL数据库。

纳入标准人群：成人≥500人，年龄≥18岁，伴有高血压或血压升高；干预：持续时间≥6个月的强化降压药物（降压目标或活性药物）的随机试验；对照组：低强度降压药治疗（血压升高目标或安慰剂）；结果：测量站立血压。

直立性高血压，定义为从坐姿改为站立后收缩压升高≥20mm Hg或舒张压升高≥10mm Hg。

数据综合两位研究者独立文章。在系统评价中确定的9个试验的个体参与者数据被附加在一起作为一个单一的数据集。

结果：在31124名参与者中，315497次站立血压评估中，9%有直立性低血压（即站立后收缩压≥20mm Hg或舒张压≥10mm Hg的血压下降），17%有直立性高血压，3.2%在基线时收缩压和站立压均升高≥140mm Hg。在直立性高血压的比值比为0.85至1.08（I2=38.0%）的试验中，强化治疗的效果相似。在随访期间，17%的接受强化治疗的患者患有直立性高血压，而19%的接受低强度治疗的患者有直立性高血压。与低强度治疗相比，高强度血压治疗的直立性高血压风险较低（比值比0.93，95%置信区间0.90至0.96）。非黑人成年人与黑人成年人（比值比0.86v0.97；相互作用P=0.003）和非糖尿病成年人与糖尿病患者（0.88v0.96；相互作用=0.05）的影响更大，但在年龄≥75岁、性别、基线坐位血压≥130/≥80mm Hg、肥胖、3期肾病、中风、心血管疾病、站立收缩压≥140mm Hg或随机化前直立性高血压方面没有差异（相互作用P≥0.05）。

研究结果表明，在这个血压升高或高血压的成人合并队列中，直立性高血压很常见，更强化的血压治疗可以适度减少直立性高血压的发生。这些发现表明，通常用于坐姿高血压的方法也可以预防站立时的高血压。

附：英文原文

Title: Effects of intensive blood pressure treatment on orthostatic hypertension: individual level meta-analysis

Author: Stephen P Juraschek, Jiun-Ruey Hu, Jennifer L Cluett, Carol Mita, Lewis A Lipsitz, Lawrence J Appel, Nigel S Beckett, Barry R Davis, Rury R Holman, Edgar R Miller, Kenneth J Mukamal, Ruth Peters, Jan A Staessen, Addison A Taylor, Jackson T Wright, William C Cushman

Issue&Volume: 2025/03/25

Abstract: Objective To determine the effects of intensive blood pressure treatment on orthostatic hypertension.

Design Systematic review and individual participant data meta-analysis.

Data sources MEDLINE, Embase, and Cochrane CENTRAL databases through 13 November 2023.

Inclusion criteria Population: ≥500 adults, age ≥18 years with hypertension or elevated blood pressure; intervention: randomized trials of more intensive antihypertensive drug treatment (lower blood pressure goal or active agent) with duration ≥6 months; control: less intensive antihypertensive drug treatment (higher blood pressure goal or placebo); outcome: measured standing blood pressure.

Main outcomes Orthostatic hypertension, defined as an increase in systolic blood pressure ≥20 mm Hg or diastolic blood pressure ≥10 mm Hg after changing from sitting to standing.

Data synthesis Two investigators independently abstracted articles. Individual participant data from nine trials identified during the systematic review were appended together as a single dataset.

Results Of 31124 participants with 315497 standing blood pressure assessments, 9% had orthostatic hypotension (that is, a drop in blood pressure after standing of systolic ≥20 mm Hg or diastolic ≥10 mm Hg), 17% had orthostatic hypertension, and 3.2% had both a rise in systolic blood pressure and standing blood pressure ≥140 mm Hg at baseline. The effects of more intensive treatment were similar across trials with odds ratios for orthostatic hypertension ranging from 0.85 to 1.08 (I2=38.0%). During follow-up, 17% of patients assigned to more intensive treatment had orthostatic hypertension, whereas 19% of those assigned less intensive treatment had orthostatic hypertension. Compared with less intensive treatment, the risk of orthostatic hypertension was lower with more intensive blood pressure treatment (odds ratio 0.93, 95% confidence interval 0.90 to 0.96). Effects were greater among non-black versus black adults (odds ratio 0.86 v 0.97; P for interaction=0.003) and adults without diabetes versus those with diabetes (0.88 v 0.96; P for interaction=0.05) but did not differ by age ≥75 years, sex, baseline seated blood pressure ≥130/≥80 mm Hg, obesity, stage 3 kidney disease, stroke, cardiovascular disease, standing systolic blood pressure ≥140 mm Hg, or pre-randomization orthostatic hypertension (P for interactions ≥0.05).

Conclusions In this pooled cohort of adults with elevated blood pressure or hypertension, orthostatic hypertension was common and more intensive blood pressure treatment modestly reduced the occurrence of orthostatic hypertension. These findings suggest that approaches generally used for seated hypertension may also prevent hypertension on standing.

DOI: 10.1136/bmj-2024-080507

Source: https://www.bmj.com/content/388/bmj-2024-080507