Gosch M
LKH Hochzirl Abteilung für Innere Medizin 6170 Zirl, Austria.
Z Gerontol Geriatr. 2000 Dec;33(6):433-7. doi: 10.1007/s003910070016.
Hypertension has a high prevalence among elderly patients. Randomised trials have already demonstrated that treating healthy older persons with hypertension is highly efficacious. Nevertheless some questions have arisen. On the one hand the generalizability of these trial results, particularly for older persons with serious medical comorbidities and poor functional status, is not clear. On the other hand different antihypertensive drugs have shown to be effective. Which drug for which patient? Even data from randomised intervention trials showing that the treatment affects cardiovascular morbidity and mortality, were missing, ACE inhibitors have been used for more than a decade to treat high blood pressure. For a younger population the captopril prevention project showed no differences between ACE inhibitors and conventional antihypertensive treatment (diuretics, beta-blocker) concerning the primary endpoints (myocardial infarction, stroke and other cardiovascular death). The STOP-2 study also confirmed these results for elderly patients. When treating elderly patients one must be aware of physiological changes with age and the comorbidities. Of significance among this patient group is declining renal function. Admissions for uraemia that are related to the use of ACE inhibitors are still commonplace, although many cases are preventable by monitoring renal function, but guidelines are still missing. Concerning the comorbidities ACE inhibitors have benefits compared to other antihypertensive drugs, especially in cases of heart failure, diabetes and coronary heart disease.
高血压在老年患者中具有很高的患病率。随机试验已经证明，对患有高血压的健康老年人进行治疗非常有效。然而，一些问题也随之出现。一方面，这些试验结果的普遍性尚不清楚，尤其是对于患有严重合并症和功能状态较差的老年人。另一方面，不同的降压药物已被证明是有效的。该给哪位患者使用哪种药物呢？即使缺乏随机干预试验的数据表明治疗会影响心血管发病率和死亡率，但血管紧张素转换酶（ACE）抑制剂已经被用于治疗高血压超过十年了。对于年轻人群，卡托普利预防项目显示，在主要终点（心肌梗死、中风和其他心血管死亡）方面，ACE抑制剂与传统降压治疗（利尿剂、β受体阻滞剂）之间没有差异。STOP - 2研究也证实了老年患者的这些结果。在治疗老年患者时，必须了解随着年龄增长的生理变化以及合并症。在这个患者群体中，肾功能下降具有重要意义。与使用ACE抑制剂相关的尿毒症住院情况仍然很常见，尽管许多病例可以通过监测肾功能来预防，但仍然缺乏相关指南。关于合并症，与其他降压药物相比，ACE抑制剂具有优势，特别是在心力衰竭、糖尿病和冠心病患者中。
