Hypertension Management in Nursing Homes: Review of Evidence and Considerations for Care.
Hypertension Management in Nursing Homes: Review of Evidence and Considerations for Care.
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DOI：
10.1007/s11906-019-1012-1
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发表时间：
2020-01-14
影响因子：
5.6
通讯作者：
Thorpe CT
中科院分区：
文献类型：
--
作者：
Vu M;Schleiden LJ;Harlan ML;Thorpe CT
我们试图总结关于疗养院（NH）居民和类似的老年复杂高血压患者的最佳血压（BP）治疗目标和降压方案强度的最新证据。最近的试验表明，在不活动的、不复杂的老年人中，更密集的血压靶标对心血管有益，但对NH居民的普遍性是值得怀疑的。其他试验表明，在体弱多病的老年患者中降压治疗是可行的，血压没有或适度升高，但大多数没有评估对以患者为中心的结果的影响。对NH居民中更具代表性的患者进行的观察性研究表明，更强化的BP治疗与危害相关，去强化治疗与降低跌倒风险相关，但研究结果和潜在的偏倚存在差异。需要随机试验和严格的观察性研究来检验去强化血压管理对复杂老年人群以患者为中心的结果的影响，从而为改善NH居民的指导和治疗提供信息。
We sought to summarize recent evidence regarding optimal blood pressure (BP) treatment targets and antihypertensive regimen intensity for nursing home (NH) residents and similar older, complex patients with hypertension. Recent trials have demonstrated cardiovascular benefits from more intensive BP targets among ambulatory, less complex older adults, but generalizability to NH residents is questionable. Other trials have demonstrated that de-intensifying antihypertensives in frail, older patients is feasible, with no or modest increases in BP, but most have not assessed effects on patient-centered outcomes. Observational studies with patients more representative of NH residents suggest harms associated with more intensive BP treatment and reduction in fall risk associated with de-intensification, but findings and potential for bias vary across studies. Randomized trials and rigorous observational studies examining effects of de-intensified BP management on patient-centered outcomes in complex, older populations are needed to inform improved guidelines and treatment for NH residents.
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DOI：
10.1136/bmj.i708
发表时间：
2016-02-24
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Mant J;McManus RJ;Roalfe A;Fletcher K;Taylor CJ;Martin U;Virdee S;Greenfield S;Hobbs FD
通讯作者：
Hobbs FD
影响因子：
6.3
作者：
Boockvar, Kenneth S.;Song, Wei;Intrator, Orna
通讯作者：
Intrator, Orna
DOI：
10.1093/gerona/glv095
发表时间：
2015-12-01
影响因子：
5.1
作者：
Marcum, Zachary A.;Perera, Subashan;Hanlon, Joseph T.
通讯作者：
Hanlon, Joseph T.
影响因子：
39
作者：
Odden, Michelle C.;Peralta, Carmen A.;Pajewski, Nicholas M.
通讯作者：
Pajewski, Nicholas M.
影响因子：
5
作者：
Hernan, Miguel A.;Robins, James M.
通讯作者：
Robins, James M.