Management of elderly patients with sustained hypertension.
Management of elderly patients with sustained hypertension.
复制标题
老年持续性高血压患者的治疗。
DOI：
10.1136/bmj.304.6824.412
复制
发表时间：
1992
影响因子：
--
通讯作者：
Peter S. Sever
中科院分区：
文献类型：
--
作者：
Victoria Infirmary Langside;Glasgow Keith;Frcp Beard;consultant physician Hugo Mascie;Mrcp Stuart Webb;Keith Beard;C. Bulpitt;Kevin O'Malley;Peter S. Sever
目的--评估治疗老年高血压患者的临床益处，并得出关于适应证、治疗目标和治疗形式的实用指南。设计--对六项已发表的随机试验的综述。结果：积极治疗老年患者的高血压与心血管发病率和死亡率的几个指数的显著改善有关，特别是致命性和非致命性中风的发生率。根据试验数据，收缩和舒张期高血压被定义为持续收缩压大于160毫米汞柱和舒张压大于90毫米汞。有令人信服的证据表明，应努力将80岁以下患者的收缩压和舒张压降低到这些水平以下。单纯的收缩期高血压被定义为收缩压大于160毫米汞柱，而舒张压小于90毫米汞。据报道，有两项试验报告称，80岁以下患者的单纯收缩期高血压的治疗受益，进一步的试验正在进行中，以支持或驳斥这一建议。利尿剂在老年患者高血压的管理中具有既定的作用；β受体拮抗剂给出了不同的结果，其益处不如利尿剂为主的治疗方案那么令人印象深刻。新的药物在治疗老年患者方面显示出希望，特别是在存在并存疾病的情况下，但它们对发病率和死亡率的影响尚未在大型随机试验中进行评估。结论--利尿剂而不是β-受体阻滞剂是无并发症高血压患者的治疗选择，但多达50%的患者可能需要联合用药。
OBJECTIVE--To assess the clinical benefits of treating hypertension in elderly patients and to derive practical guidelines regarding indications, goals, and forms of treatment. DESIGN--Review of six published randomised trials. RESULTS--Active treatment of hypertension in elderly patients was associated with significant improvements in several indices of cardiovascular morbidity and mortality, particularly the incidence of fatal and non-fatal strokes. On the basis of the trial data, combined systolic and diastolic hypertension was defined as a sustained systolic pressure greater than 160 mmHg and diastolic pressure greater than 90 mmHg. There is convincing evidence that efforts should be made to reduce both systolic and diastolic pressures to below these levels in patients up to the age of 80 years. Isolated systolic hypertension was defined as a systolic pressure greater than 160 mmHg in the presence of a diastolic pressure less than 90 mmHg. Two trials reported benefit from the treatment of isolated systolic hypertension in patients up to the age of 80, and further trials are underway to support or refute this recommendation. Diuretics have an established role in the management of hypertension in elderly patients; beta adrenoceptor antagonists have given variable results, and the benefits are less impressive than with diuretic based regimens. Newer agents show promise in the treatment of elderly patients, particularly in the presence of coexisting disease, but their effects on morbidity and mortality have not been evaluated in large randomised trials. CONCLUSIONS--Diuretics rather than beta blockers are the treatment of choice for patients with uncomplicated hypertension, but combinations of drugs may be required in as many as 50% of patients.