内科

目的探讨老年高血压合并体位性低血压（OH）患者发生心脑血管事件的危险因素。方法选取2018年1月至2020年1月我院收治的老年高血压合并OH患者135例作为研究对象，对患者进行为期1年的随访，根据是否发生主要心脑血管事件将患者分为事件组（52例）和无事件组（83例）。比较两组患者的性别、年龄、体质量指数（BMI）、病程、是否抽烟、是否饮酒、有无糖尿病、脉压、舒张压（DBP）、收缩压（SBP）、高密度脂蛋白胆固醇（HDL-C）和低密度脂蛋白胆固醇（LDL-C）水平；绘制ROC曲线，分析根据SBP和 LDL-C水平预测高血压合并OH患者发生心脑血管事件的价值；对高血压合并OH患者发生心脑血管事件的危险因素进行非条件Logistic回归分析。结果单因素分析结果显示，事件组患者的BMI≥24 kg/m2、抽烟、合并糖尿病比例显著高于无事件组，事件组患者的SBP、LDL-C水平显著高于无事件组，差异有统计学意义（P＜0.05）。ROC分析结果显示，根据SBP和LDL-C水平预测高血压合并OH患者发生心脑血管事件的曲线下面积分别为 0.885、0.723；诊断的最佳截断值分别为141.647 mmHg和1.791 mmol/L。Logistic回归分析结果显示，肥胖、抽烟、合并糖尿病、SBP≥141.647 mmHg、LDL-C≥1.791 mmol/L是高血压合并OH患者发生心脑血管事件的独立危险因素（P＜0.05）。结论根据SBP和LDL-C水平预测高血压合并 OH患者发生心脑血管事件的敏感度、特异度均较高，具有一定的临床应用价值。

ObjectiveTo investigate the risk factors for cardiovascular and cerebrovascular events in elderly patients with hypertension complicated with orthostatic hypotension (OH). MethodsA total of 135 elderly patients with hypertension complicated with OH admitted to our hospital from January 2018 to January 2020 were selected as the research objects. All patients were followed up for one year. According to the presence of the major cardiovascular and cerebrovascular events occurrence, the patients were divided into event group (52 cases) and no event group (83 cases). The gender, age, body mass index (BMI), course of disease, smoking or alcohol drinking, diabetes of the two groups were compared, and the levels of pulse pressure, diastolic blood pressure (DBP), systolic blood pressure (SBP), high-density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C) were detected and compared between the two groups. ROC curve was drawn to analyze the value of SBP and LDL-C levels in predicting cardiovascular and cerebrovascular events in patients with hypertension complicated with OH. Logistic regression analysis was used to analyze the risk factors for cardiovascular and cerebrovascular events in patients with hypertension complicated with OH. ResultsThe results of univariate analysis showed that the event group yielded significantly higher proportions in BMI≥24 kg/m2, smoking and diabetes, and higher levels of SBP, LDL-C as compared with the no event group, with statistically significant differences (P＜0.05). The results of ROC analysis revealed that the area under the curve of SBP and LDL-C levels in predicting cardiovascular and cerebrovascular events in patients with hypertension complicated with OH were 0.885 and 0.723, respectively. The best cut-off values for diagnosis were 141.647 mmHg and 1.791 mmol/L, respectively. The results of logistic regression analysis interpreted that obesity, smoking, diabetes, SBP＞141.647 mmHg, LDL-C＞1.791 mmol/L were risk factors for cardiovascular and cerebrovascular events in patients with hypertension complicated with OH (P＜0.05). ConclusionObesity, smoking, diabetes, SBP＞ 141.647 mmHg, LDL-C＞1.791 mmol/L are risk factors for cardiovascular and cerebrovascular events in patients with hypertension complicated with OH. The sensitivity and specificity of SBP and LDL-C levels in predicting cardiovascular and cerebrovascular events in patients with hypertension complicated with OH are high, which has certain clinical application values.