Beard K, Bulpitt C, Mascie-Taylor H, O'Malley K, Sever P, Webb S
Victoria Infirmary Langside, Glasgow.
BMJ. 1992 Feb 15;304(6824):412-6. doi: 10.1136/bmj.304.6824.412.
To assess the clinical benefits of treating hypertension in elderly patients and to derive practical guidelines regarding indications, goals, and forms of treatment.
Review of six published randomised trials.
Active treatment of hypertension in elderly patients was associated with significant improvements in several indices of cardiovascular morbidity and mortality, particularly the incidence of fatal and non-fatal strokes. On the basis of the trial data, combined systolic and diastolic hypertension was defined as a sustained systolic pressure greater than 160 mmHg and diastolic pressure greater than 90 mmHg. There is convincing evidence that efforts should be made to reduce both systolic and diastolic pressures to below these levels in patients up to the age of 80 years. Isolated systolic hypertension was defined as a systolic pressure greater than 160 mmHg in the presence of a diastolic pressure less than 90 mmHg. Two trials reported benefit from the treatment of isolated systolic hypertension in patients up to the age of 80, and further trials are underway to support or refute this recommendation. Diuretics have an established role in the management of hypertension in elderly patients; beta adrenoceptor antagonists have given variable results, and the benefits are less impressive than with diuretic based regimens. Newer agents show promise in the treatment of elderly patients, particularly in the presence of coexisting disease, but their effects on morbidity and mortality have not been evaluated in large randomised trials.
Diuretics rather than beta blockers are the treatment of choice for patients with uncomplicated hypertension, but combinations of drugs may be required in as many as 50% of patients.
评估老年患者高血压治疗的临床益处，并得出关于治疗指征、目标和形式的实用指南。
对六项已发表的随机试验进行综述。
老年患者积极治疗高血压与心血管发病率和死亡率的几个指标显著改善相关，尤其是致命和非致命性中风的发生率。根据试验数据，收缩压和舒张压联合高血压定义为持续收缩压大于160 mmHg且舒张压大于90 mmHg。有令人信服的证据表明，对于80岁以下的患者，应努力将收缩压和舒张压都降至这些水平以下。单纯收缩期高血压定义为舒张压小于90 mmHg时收缩压大于160 mmHg。两项试验报告了80岁以下患者治疗单纯收缩期高血压的益处，目前正在进行进一步试验以支持或反驳这一建议。利尿剂在老年患者高血压管理中已确立作用；β肾上腺素能受体拮抗剂的结果不一，其益处不如基于利尿剂的治疗方案显著。新型药物在老年患者治疗中显示出前景，尤其是在存在合并症的情况下，但它们对发病率和死亡率的影响尚未在大型随机试验中评估。
对于无并发症的高血压患者，利尿剂而非β受体阻滞剂是首选治疗药物，但多达50%的患者可能需要联合用药。
