Nilsson Peter M
Department of Medicine, University Hospital, Malmö, Sweden.
Drugs Aging. 2005;22(6):517-24. doi: 10.2165/00002512-200522060-00005.
The risk of ischaemic or haemorrhagic stroke is increased in patients with hypertension, with a linear relationship between elevation of blood pressure and stroke risk being seen even in normotensive individuals. In elderly subjects it has been shown that systolic blood pressure (SBP) elevation in particular is the most important risk predictor for stroke. This is also the rationale for treating elevated SBP in the elderly. Several clinical trials have repeatedly shown the benefits of blood pressure control for prevention of stroke and also for dementia, both of the multi-infarct and Alzheimer subtype. Remaining research questions involve the proper and evidence-based choice of drug treatment in the elderly hypertensive patient. In spite of the introduction of many newer antihypertensive drugs, use of thiazide diuretics is still one of the best treatment choices, as this class of drugs is well proven and cost effective. Another question concerns when and how to treat patients >80 years of age. An ongoing randomised clinical trial, the Hypertension in the Very Elderly trial, is currently trying to evaluate risks and benefits of antihypertensive treatment in this age category.
高血压患者发生缺血性或出血性卒中的风险增加，即使在血压正常的个体中，血压升高与卒中风险之间也呈线性关系。在老年受试者中，已表明尤其是收缩压（SBP）升高是卒中最重要的风险预测因素。这也是治疗老年患者SBP升高的理论依据。多项临床试验反复表明，控制血压对预防卒中和痴呆（包括多发梗死性和阿尔茨海默型痴呆）均有益处。尚存的研究问题包括老年高血压患者药物治疗的合理且基于证据的选择。尽管引入了许多更新的抗高血压药物，但噻嗪类利尿剂的使用仍是最佳治疗选择之一，因为这类药物已得到充分验证且具有成本效益。另一个问题涉及何时以及如何治疗80岁以上的患者。一项正在进行的随机临床试验——高龄老人高血压试验，目前正在试图评估该年龄组抗高血压治疗的风险和益处。
