Lund-Johansen P
Department of Cardiology, University of Bergen, School of Medicine, Norway.
Cardiovasc Drugs Ther. 1992 Dec;6(6):571-3. doi: 10.1007/BF00052556.
Treatment of hypertension in the elderly has so far mainly been based on clinical judgment and very few large controlled trials. During the last year several large new trials have been published, the so-called STOP-Hypertension, SHEP, and MRC trials. All have shown that drug treatment of hypertension in the elderly (65-85 years) with permanent diastolic hypertension or isolated systolic hypertension reduces stroke incidence. Most patients have needed combined drug treatment with diuretics and beta-blockers. When thiazide diuretics are used, serum potassium should be followed very closely and most likely amiloride should be added to the thiazide therapy, since this was done both in the STOP and the MRC trials. Since many elderly patients with hypertension suffer from other diseases that might represent contraindications to thiazide diuretics or beta-blockers, the choice of drug must be made after careful clinical evaluation. With the newer classes of antihypertensive agents (calcium antagonists, ACE inhibitors and alpha-blockers) side effects are probably seen less often, but long-term data on morbidity and mortality are still lacking.
迄今为止，老年高血压的治疗主要基于临床判断，且很少有大型对照试验。在过去一年里，已发表了几项大型新试验，即所谓的“老年收缩期高血压治疗研究（STOP-Hypertension）”、“收缩期高血压计划（SHEP）”和“医学研究委员会（MRC）试验”。所有这些试验均表明，对患有持续性舒张期高血压或单纯收缩期高血压的老年患者（65 - 85岁）进行药物治疗可降低中风发生率。大多数患者需要联合使用利尿剂和β受体阻滞剂进行药物治疗。使用噻嗪类利尿剂时，应密切监测血清钾水平，并且很可能应在噻嗪类治疗中添加氨苯蝶啶，因为在“老年收缩期高血压治疗研究”和“医学研究委员会试验”中均采用了这种做法。由于许多老年高血压患者患有其他可能成为噻嗪类利尿剂或β受体阻滞剂禁忌证的疾病，因此必须在仔细的临床评估后做出药物选择。对于新型抗高血压药物（钙拮抗剂、血管紧张素转换酶抑制剂和α受体阻滞剂），副作用可能较少见，但关于发病率和死亡率的长期数据仍然缺乏。
