直立性低血压(OH)是否是心血管发病和死亡的危险因素尚不明确，当前的证据多源于不均等和部分有争议的研究。欧洲学者对上述问题进行了一项荟萃分析研究，结果表明，OH与全因死亡、冠心病(CHD)发生、心力衰竭(HF)和卒中风险增加有关。相关论文4月7日在线发表于《欧洲心脏杂志》(Eur Heart J)。

该研究对1966至2013年已发表的有关OH与死亡、严重不良心脑血管事件(MACCE)关系的前瞻观察性研究进行了荟萃分析，评估最长随访时间主要(全因死亡)和次要终点(包括冠心病、HF和卒中)的相对危险度(RR)和95%置信区间(95% CI)。根据年龄和荟萃回归分析对亚组患者进行事后分析。

结果共13项研究中的121 913例患者纳入分析中，中位随访时间为6年。与那些不存在OH的受试者相比，OH的发生与主要和次要终点发生风险显著增加有关，全因死亡的RR值为1.50，95% CI ：1.24–1.81;冠心病、HF和卒中的RR值分别为1.41、2.25和1.64，95% CI 分别为(1.22–1.63)、(1.52–3.33)和(1.13–2.37)。根据年龄进行分析时，65岁以下和65岁以上患者全因死亡的RR综合估计值分别为1.78(1.25–2.52)和1.26(0.99–1.62)。

参考文献：

Fabrizio Ricci,et al. Eur Heart J.First published online: 7 April 2015.DOI: http://dx.doi.org/10.1093/eurheartj/ehv093

Cardiovascular morbidity and mortality related to orthostatic hypotension: a meta-analysis of prospective observational studies

Fabrizio Ricci , Artur Fedorowski , Francesco Radico , Mattia Romanello , Alfonso Tatasciore , Marta Di Nicola , MarcoZimarino , Raffaele De Caterina
DOI: http://dx.doi.org/10.1093/eurheartj/ehv093 First published online: 7 April 2015
Abstract
Background Whether orthostatic hypotension (OH) is a risk factor for cardiovascular morbidity and death is uncertain. Currently available evidence derives from non-homogeneous and partly ambiguous studies.
Objective We aimed at assessing the relationship between OH and death or major adverse cardiac and cerebrovascular events (MACCEs) by integrating results of previous studies.
Methods We performed a meta-analysis of prospective observational studies reporting on the association between prevalent OH, mortality, and incident MACCE, published from 1966 through 2013. Mantel–Haenszel pooled estimates of relative risk (RR) and 95% confidence intervals (CIs) for all-cause death were assessed as the primary endpoint at the longest follow-up; incident coronary heart disease (CHD), heart failure (HF), and stroke were assessed as secondary endpoints. We also performed post hoc subgroup analyses stratified by age and a meta-regression analysis.
Results We identified a total of 13 studies, including an overall population of 121 913 patients, with a median follow-up of 6 years. Compared with the absence of OH, the occurrence of OH was associated with a significantly increased risk of all-cause death (RR 1.50; 95% CI 1.24–1.81), incident CHD (RR 1.41; 95% CI 1.22–1.63), HF (RR 2.25; 95% CI 1.52–3.33), and stroke (RR 1.64; 95% CI 1.13–2.37). When analysed according to age, pooled estimates of RR (95% CI) for all-cause death were 1.78 (1.25–2.52) for patients <65 years old, and 1.26 (0.99–1.62) in the older subgroup.
Conclusion Orthostatic hypotension is associated with a significantly increased risk of all-cause death, incident CHD, HF, and stroke.