直立生命体征
医学
仰卧位
血压
不利影响
米多君
麻醉
重症监护医学
心脏病学
内科学
作者
Inbar Raber,Matthew J Belanger,Rosemary Farahmand,Rahul Aggarwal,Nicholas Chiu,Mahmoud Al Rifai,Alan P Jacobsen,Lewis A. Lipsitz,Stephen P. Juraschek
出处
期刊:Hypertension
[Ovid Technologies (Wolters Kluwer)]
日期:2022-11-01
卷期号:79 (11): 2388-2396
被引量:4
标识
DOI:10.1161/hypertensionaha.122.18557
摘要
Orthostatic hypotension affects roughly 10% of individuals with hypertension and is associated with several adverse health outcomes, including dementia, cardiovascular disease, stroke, and death. Among adults with hypertension, orthostatic hypotension has also been shown to predict patterns of blood pressure dysregulation that may not be appreciated in the office setting, including nocturnal nondipping. Individuals with uncontrolled hypertension are at particular risk of orthostatic hypotension and may meet diagnostic criteria for the condition with a smaller relative reduction in blood pressure compared with normotensive individuals. Antihypertensive medications are commonly de-prescribed to address orthostatic hypotension; however, this approach may worsen supine or seated hypertension, which may be an important driver of adverse events in this population. There is significant variability between guidelines for the diagnosis of orthostatic hypotension with regards to timing and position of blood pressure measurements. Clinically relevant orthostatic hypotension may be missed when standing measurements are delayed or when taken after a seated rather than supine position. The treatment of orthostatic hypotension in patients with hypertension poses a significant management challenge for clinicians; however, recent evidence suggests that intensive blood pressure control may reduce the risk of orthostatic hypotension. A detailed characterization of blood pressure variability is essential to tailoring a treatment plan and can be accomplished using both in-office and out-of-office monitoring.
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