Nikolaus T, Sommer N, Becker C
Bethesda Geriatrische Klinik/Universität Ulm Zollernring 26 89073 Ulm Germany.
Z Gerontol Geriatr. 2000 Dec;33(6):427-32. doi: 10.1007/s003910070015.
Hypertension increases in prevalence with age. Population based studies suggest that more than 50% of people over the age of 65 years may have chronic hypertension. Hypertension, especially systolic hypertension, is the single most common, powerful, however, treatable risk factor for cardiovascular morbidity and mortality in the elderly. In order to assess the effectiveness of antihypertensive drug therapy among the elderly, with diuretics, beta-blockers and calcium channel blockers, a literature search was performed at the Cochrane Library, Medline and Excerpta medica. The Cochrane Hypertension Group identified 14 randomised controlled trials of at least one year duration with 21,785 elderly subjects where diuretics, beta-blockers or calcium channel blockers were used in the treatment group as first line drugs. In their meta-analysis (including one small trial with a central acting antiadrenergic drug) there was a decrease in total mortality (111 vs 129 deaths) and cardiovascular morbidity and mortality (126 vs 177 events) within the treatment group. The three trials restricted to persons with isolated systolic hypertension indicated beneficial effects in the treatment group with regard to cardiovascular morbidity and mortality (104 vs 157 events). Trial data on adverse effects is limited. In three studies, where adverse effects were reported, no substantial differences between treatment and control groups in measures of physical, cognitive and emotional function were found. Cardiovascular benefits of treatment with low dose diuretics or beta-blockers are cleared for elderly subjects with either diastolic or isolated systolic hypertension. Treatment with a long-acting dihydropyridine calcium channel blocker shows beneficial effects in reducing cardiovascular morbidity and mortality for elderly people with isolated systolic hypertension. Due to inconsistent findings in a subgroup meta-analysis of antihypertensive drug treatment in very old people, the efficacy of antihypertensive treatment in these subjects still remains unclear.
高血压的患病率随年龄增长而增加。基于人群的研究表明，65岁以上的人群中超过50%可能患有慢性高血压。高血压，尤其是收缩期高血压，是老年人心血管发病和死亡的最常见、最有力但可治疗的单一危险因素。为了评估利尿剂、β受体阻滞剂和钙通道阻滞剂在老年人中抗高血压药物治疗的有效性，我们在考克兰图书馆、医学文献数据库和医学文摘数据库进行了文献检索。考克兰高血压小组确定了14项至少为期一年的随机对照试验，共有21785名老年受试者，治疗组将利尿剂、β受体阻滞剂或钙通道阻滞剂作为一线药物使用。在他们的荟萃分析（包括一项使用中枢作用抗肾上腺素能药物的小型试验）中，治疗组的总死亡率（111例对129例死亡）以及心血管发病和死亡率（126例对177例事件）有所下降。三项仅限于单纯收缩期高血压患者的试验表明，治疗组在心血管发病和死亡率方面有有益效果（104例对157例事件）。关于不良反应的试验数据有限。在三项报告了不良反应的研究中，未发现治疗组和对照组在身体、认知和情绪功能指标上有实质性差异。低剂量利尿剂或β受体阻滞剂治疗对患有舒张期或单纯收缩期高血压的老年受试者具有心血管益处。长效二氢吡啶类钙通道阻滞剂治疗对患有单纯收缩期高血压的老年人在降低心血管发病和死亡率方面显示出有益效果。由于在非常老年人抗高血压药物治疗的亚组荟萃分析中结果不一致，这些受试者抗高血压治疗的疗效仍不明确。
