. ., 253 II

, 2009,
8,
2
.
.,
.
«
»
.
.
253
II
34,7%
,
,
,
,
,
( <0,05)
.
,
( <0,05)
10,2%,
,
.
5,2 (
2,3-11,8)
,
.
:
,
,
.
Abstract. 253 patients suffering from essential hypertension of II degree
were studied. 34,7% of patients have orthostatic hypotension during active
orthostatic test, this being accompanied by an increase in the rate of lethal
outcomes, total number of strokes, myocardial infarction, cases of arhythmia,
unstable angina pectoris and lethal outcomes ( <0,05) within a year. Correction of
hypotensive therapy with regard to superfluous orthostatic reactions, allows to
lower reliably ( <0,05) the incidence of orthostatic hypotension up to 10,2%, the
total number of adverse events, the number of emergency calls and
hospitalizations. Relative risk of adverse events development is in sum 5,2 (ID
1
, 2009,
8,
2
2,3-11,8) times lower in patients with correction of hypotensive therapy than in
the control subgroup.
:
, 210009 .
107,
(
,
. 23-79-93 -
.
24 - 1.
)
-
,
.
,
,
).
,
).
,
,
(
).
.
(
20
.
10
)
.
(
30
,
120
10
) [1, 2, 3].
[4].
2
, 2009,
8,
2
(
)
,
(
,
,
1,3
) [5, 6, 7, 8, 9, 10, 11, 12].
(
1,8
,
(
(
) 1,08-1,57),
1,25-2,60) [10].
ARIC
2
1,2-3,2) [7].
1
[7, 11, 12].
,
,
,
[13, 14].
,
,
-
.
,
.
,
.
.
II
.
3
, 2009,
8,
2
253
II
,
.
9,9±8,9
.
, 1999.
2
.
I
)
,
.
II
.
1.
.
1
253
145
108
I
II
130
70
60
123
75
48
.
,
30
14
,
,
,
)
56,4±10,9
56,9±11,4
55,2±10,2
22 –
38
12 –
II
,
–
II
,
27 –
I-
34 –
, 18
, 15 –
.
:
,
III-IV
,
,
4
, 2009,
8,
3
2
,
,
.
,
20-40
10-20
50-100
25-100
,
5-10
,
2,5
.
I
II
.
(
1,5-2
)
.
10
,
,
).
3-5
1-
,
5-
.
,
.
,
,
,
108
.
(II
7, 12, 17
)
22
.
,
Watch BP O3
Microlife.
,
,
,
(
,
.).
,
:
[1, 2, 3].
:
5
, 2009,
8,
2
–
.
–
,
,
.
–
,
-
.
1.
1
:
•
.
•
(
,
)
-
.
2.
•
.
•
.
3.
•
.
•
.
4.
•
•
.
,
,
,
,
,
.
.
389,9±156,5
6
(1,1±0,4
).
, 2009,
8,
2
6.0.
±
[15].
(
170,5±24,9
.,
(
) 98,4±14,4
89%
38%
)
.
,
–
.
,
,
I
.
129,8±6,1
.,
.,
81,5±4,7
79,3% (n=115)
131,7±7,4
.,
.
83,6± 5,7
79,6% (n=86)
II
.,
.
1-2
34,7% (n=88)
I
50 (34,5%)
,
II
-
.
38 (35,2%).
II
11
(
49; 45,4%).
(49,1%).
,
92,6%, 8
,
.
7-11
35 (24,1%)
I
.
II
11 (10,2%)
7
( <0,05).
, 2009,
8,
2
2.
2
(
)
1-3
7-11
%
I
II
I
II
I
II
I
II
I II
15
9
33
26
2
3
50
38
88
10,3
8,3
22,8
24,1
1,4
2,8
34,5
35,2
34,7
%
13,1
5,6
11
4,6
0
0
24,1
10,2
18,2
19
6
16*
5*
0
0
35*
11*
46*
: * –
;
I
II
( <0,05).
,
1-3
.
3.
3
(
n=253
4
3
16
17
6
n=88
3
2
9
8
5
n=165
1
1
7
9
1*
2
1
1
142
67
70
33
72*
34*
)
: * – <0,05
.
8
, 2009,
8,
2
1,1±0,4
,
1-3
–
,
.
,
)
<0,05)
(n=27),
(n=19).
,
.
9,38 (
2,84 (
11,1-79,2),
1,7-4,78)
,
.
(
. 4):
4
I
(
)
-
(
)
.
n=145
3
4
14
14
6
II
.
n=108
0
0
2*
3
0
1
105
53
1
37*
14*
: * – <0,05
5,2 (
.
2,3-11,8)
,
.
9
, 2009,
8,
2
,
34,7%
.
Watch BP O3
<0,05)
,
.
,
.
,
,
.
,
(
,
,
)
(n=6),
(n=41, <0,05).
,
II
( <0,05).
1.
34,7%
II
.
(
.
10
49,1%,
<0,05),
, 2009,
8,
2
2.
,
,
,
,
( <0,05)
.
3.
,
( <0,05)
10,2%
(24,1%),
,
,
,
,
,
).
1. Consensus statement on definition of orthostatic hypotension, pure
autonomic failure and multiple system atrophy. The Consensus Committee of the
American Autonomic Society and the American Academy of Neurology (special
article) // Neurology. – 1996. – Vol. 46. – P. 1470.
2. Mansoor, G. A. Orthostatic hypotension due to autonomic disorders in
the hypertension clinic / G. A. Mansoor // Am. J. Hypertens. – 2006. – Vol. 19. –
N 3. – . 319-323.
3. Postural tachycardia syndrome (POTS) / P. A. Low [et al.] // Neurology.
– 1995. – Vol. 45. – . 19-25.
4. Stewart, J. M. Vascular perturbations in the chronic orthostatic
intolerance of the postural orthostatic tachycardia syndrome / J. M. Stewart,
A. Weldon // J. Appl. Physiol. – 2000. – Vol. 89. – P. 1505-1512.
5. Eigenbrodt, M. L. Orthostatic hypotension as a risk factor for stroke: the
atherosclerosis risk in communities (ARIC) study 1987–1996 / M. L. Eigenbrodt,
K. M. Rose, D. J. Couper // Stroke. – 2000. – Vol. 31. – . 2307-2313.
6. Orthostatic hypotension and the incidence of coronary heart disease: the
Atherosclerosis Risk in Communities (ARIC) Study / K. Rose [et al.] // Am. J.
Hypertens. – 2000. – Vol. 13. – . 571-578.
11
, 2009,
8,
2
7.
:
,
/
. .
[
8.
.] //
. – 2008. –
10. – . 19-23.
, . .
/
. .
,
:
.
.–
. .
. II
//
.
.-
, 2002. – . 59-60.
9. Masaki, K. H. Orthostatic hypotension predicts mortality in elderly men:
the Honolulu Heart Program. / K H. Masaki, I. J. Schatz, C M. Burchfiel //
Circulation. – 1998. – Vol. 98. – . 2290–2295.
10.
Orthostatic Hypotension and Risk of Cardiovascular Disease in
Elderly People: The Rotterdam Study / C. Verwoert, [et al.] // Journal of the
American Geriatrics Society. – 2008. – Vol. 56, N 10. – . 1816-1820.
11.
Prevalence, predisposing factors, and prognostic importance of
postural hypotension. / I. Räihä [et al.] // Arch. Intern. Med. – 1995. – Vol. 155, N
9. – P. 930-935.
12.
Prognosis of diastolic and systolic orthostatic hypotension in older
persons. / H. Luukinen [et al.] // Arch. Intern. Med. – 1999. – Vol. 159, N 3. – P.
273-280.
13.
Chobanian, A. V. The seventh report of the Joint National Committee
on prevention, detection, evaluation, and treatment of high blood pressure: The
JNC 7 report / A. V. Chobanian, G. L. Bakris, H. R. Black // JAMA. – 2003. –
Vol. 289. – P. 2560-2572.
14.
Mancia, G. Guidelines for the management of arterial hypertension. /
G. Mancia, G. De Backer // European Heart Journal. – 2007. – Vol. 28. – P.
1462–1536.
15.
, .
/ .
.–
., 2001. – . 649.
12