Hypertension and Polypharmacy in Elderly Nursing Home Residents: When Less is More.
Hypertension and Polypharmacy in Elderly Nursing Home Residents: When Less is More.
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老年疗养院居民的高血压和多重用药：少即是多。
DOI：
10.1053/j.ajkd.2015.06.012
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发表时间：
2015
期刊：
影响因子：
--
通讯作者：
Beddhu,Srinivasan
中科院分区：
文献类型：
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作者：
Raphael,KalaniL;Beddhu,Srinivasan
高血压的患病率随着年龄的增长而增加，例如60岁以上的美国成年人中有三分之二患有高血压。高血压是老年人心血管疾病的主要危险因素，近75%的首次中风、心肌梗死或充血性心力衰竭患者患有高血压。治疗老年人中度高血压，特别是那些有广泛合并症的老年人，是否会减少不良事件尚不确定。多种用药在老年人中很常见，可能导致严重的并发症。老年高血压试验（HYVET）研究了使用噻嗪类利尿剂联合或不联合血管紧张素转换酶抑制剂将血压降至< 150/80 mm Hg是否能改善80岁以上老年人的临床结果。在HYVET之前，人们担心降低血压可能会降低中风风险，但会增加老年高血压患者的死亡风险。例如，一项对4071名80岁或以上的高血压退伍军人的观察性研究报告称，收缩压< 140 mm Hg的人的生存期较短，即使在调整了基线死亡预测因子后也是如此。然而，HYVET研究显示，将血压降至< 150/80 mm Hg可使卒中风险降低30%，致命性卒中风险降低39%，心力衰竭风险降低64%，全因死亡率降低21%。
The prevalence of hypertension increases with advancing age, such that two-thirds of US adults 60 years or older have hypertension. 1 Hypertension is a major risk factor for cardiovascular disease in older adults, 2 with nearly 75% of people with first stroke, myocardial infarction, or congestive heart failure having hypertension. 3 Whether treating moderate hypertension in older adults, particularly those with extensive comorbid conditions, will reduce adverse events is less certain. Polypharmacy is common in older people and may result in significant complications. 4The Hypertension in the Very Elderly Trial (HYVET) 5 examined whether lowering blood pressure (BP) to< 150/80 mm Hg using a thiazide diuretic with or without an angiotensinconverting enzyme inhibitor improved clinical outcomes in individuals older than 80 years. Prior to HYVET, there were concerns that lowering BP might reduce stroke risk yet increase mortality risk in elderly individuals with hypertension. For instance, an observational study of 4,071 ambulatory veterans 80 years or older with hypertension reported shorter survival for those with systolic BP (SBP)< 140 mm Hg, even after adjustment for baseline predictors of death. 6 However, HYVET showed that lowering BP to< 150/80 mm Hg reduced the risks of stroke by 30%, fatal stroke by 39%, heart failure by 64%, and all-cause mortality by 21%.