老年餐后低血压及其心脑血管损害的研究进展

doi:10.16138/j.1673-6087.2024.05.11

摘要/Abstract

摘要：

老年人最常见的低血压综合征包括直立性低血压（orthostatic hypotension，OH）、餐后低血压（postprandial hypotension，PPH）、颈动脉窦综合征和血管迷走神经性晕厥1型^[1]，其中发病率较高的是PPH。PPH于1977年正式提出，不断充实的证据表明，PPH是不同心血管疾病的风险因素。PPH与心血管疾病和老年人全因死亡率有关^[2]，但因症状不典型经常被忽视。本文就老年人PPH及其与心脑血管损害的最新研究进展作一综述。

关键词: 老年, 餐后低血压, 心脑血管损害, 流行病学

Abstract:

The most common hypotensive syndromes in the elderly include orthostatic hypotension (OH), postprandial hypotension (PPH), carotid sinus syndrome, and vasovagal syncope type 1. Among them, PPH has a higher incidence. PPH was formally proposed in 1977, and evolving evidence suggests that PPH is a risk factor for different cardiovascular diseases. PPH is associated with cardiovascular disease and all-cause mortality in the elderly, but is often overlooked due to atypical symptoms. This article reviews the latest research progress of PPH and its relationship with cardiovascular and cerebrovascular damage in the elderly.

Key words: Elderly people, Postprandial hypotension, Cardiovascular and cerebrovascular damage, Epidemiology

中图分类号:

R544.2

谢晓萌, 龚艳春. 老年餐后低血压及其心脑血管损害的研究进展[J]. 内科理论与实践, 2024, 19(05): 342-346.

XIE Xiaomeng, GONG Yanchun. Research progress of postprandial hypotension and its relationship with cardiovascular and cerebrovascular damage in the elderly[J]. Journal of Internal Medicine Concepts & Practice, 2024, 19(05): 342-346.

图/表 1

参考文献 58

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药物	作用
α-葡萄糖苷酶抑制药（阿卡波糖^[45]、伏格列波糖）	竞争性抑制小肠黏膜上皮的蔗糖酶和葡萄糖淀粉酶，延缓碳水化合物消化吸收；阿卡波糖可用于颈脊髓损伤患者合并PPH^[46-47]；改善老年T2DM患者合并PPH的餐后血压波动^[48]；治疗PPH机制可能为通过减少餐后胃肠道血流灌注^[49]
二甲双胍	减缓肠道葡萄糖的吸收并增加去甲肾上腺素的分泌^[50]；可用于T2DM合并PPH患者，不仅可减轻收缩压下降，还增加血浆GLP-1浓度并减缓胃排空^[51]
GLP-1（艾塞那肽、利司那肽^[52]）	减缓胃排空并促进胰岛素分泌；增加餐后平均动脉血压和心率^[53]；减少肠系膜上动脉血流增加
DPP-4抑制剂	有效提高血浆GLP-1水平，利格列汀不会影响空腹血压，且可减弱餐后收缩压的下降^[54]
瓜尔胶、咖啡因、奥曲肽、GIP拮抗剂^[55]	通过减少内脏血流也可改善餐后血压下降；咖啡因可以预防PPH相关的晕厥^[56]
去甲肾上腺素前体（DL-DOPS）	在外周和中枢神经系统转化为去甲肾上腺素，提高交感神经活性