Benefits of blood pressure reduction in elderly patients
Benefits of blood pressure reduction in elderly patients
复制标题
降低老年患者血压的好处
DOI：
10.1097/00004872-200307006-00005
复制
发表时间：
2003
影响因子：
4.9
通讯作者：
R. Asmar
中科院分区：
文献类型：
--
作者：
R. Asmar
老年人高血压的主要特征是收缩压（SBP）升高。因此，单纯收缩期高血压（ISH）是该人群中最常见的亚型。ISH的主要血流动力学决定因素是大动脉僵硬度增加。这表现为SBP升高和舒张压（DBP）降低，导致脉压变宽。流行病学研究表明，ISH和老年人的脉压增加构成了独立的心血管危险因素，在预测高血压的不良心血管后遗症方面可能比单独的DBP升高更可靠。使用常规和新型降压药降低高血压（>140/90 mmHg），包括ISH（SBP ≥140 mmHg，DBP <90 mmHg），可显著降低主要冠状动脉事件、卒中、冠心病和全因死亡率的风险。在老年人群中，似乎没有年龄阈值，超过该阈值，高血压治疗（包括ISH）不应被认为是有益的。临床管理必须考虑到与其病理生理学和该人群的患者特征相关的一些特定方面。虽然治疗目标是<140/90 mmHg，但即使未达到总体目标，SBP降低20-30 mmHg也与预后改善相关。
Hypertension in the elderly is characterized principally by increased systolic blood pressure (SBP). Consequently, isolated systolic hypertension (ISH) is the most common subtype in this population. The major haemodynamic determinant underlying ISH is increased large-artery stiffness. This is expressed as an increase in SBP and decrease in diastolic blood pressure (DBP), leading to widening pulse pressure. Epidemiological studies show that ISH and increased pulse pressure in the elderly constitute independent cardiovascular risk factors and may be more robust in predicting the adverse cardiovascular sequelae of hypertension than elevated DBP alone. Reducing high blood pressure (>140/90 mmHg), including ISH (SBP ≥140 mmHg, DBP <90 mmHg), with conventional and newer antihypertensive agents significantly reduces the risk of major coronary events, stroke, coronary heart disease and all-cause mortality. Among the elderly population, there appears to be no age threshold beyond which treatment of hypertension, including ISH, should not be considered beneficial. Clinical management has to take into account some specific aspects related to its pathophysiology and the patient characteristics of this population. Although the therapeutic goal is <140/90 mmHg, a decrease of 20-30 mmHg in SBP, even if the overall goal is not achieved, is associated with improved prognosis.
影响因子：
37.8
作者：
Franklin, SS;Khan, SA;Levy, D
通讯作者：
Levy, D