Franklin Stanley S
Heart Disease Prevention Program, University of California, Irvine, 92697, USA.
J Clin Hypertens (Greenwich). 2006 Jul;8(7):521-5. doi: 10.1111/j.1524-6175.2006.05116.x.
There is overwhelming evidence that pharmacologic treatment of isolated systolic hypertension (ISH) (systolic blood pressure >or=140 mm Hg and diastolic blood pressure <90 mm Hg) reduces cardiovascular events and extends longevity in the elderly; in the very old (80 years or older), the evidence supports decreased incident stroke and heart failure, but is less convincing in terms of longevity. Thus, the inherent increased risk for ISH vascular events highlights the importance of its control. Importantly, ISH in the elderly, primarily related to large artery stiffness, remains more difficult to control than diastolic hypertension in the young, which is primarily related to increased peripheral vascular resistance. Appropriate lifestyle and pharmacologic intervention is indicated in individuals with systolic blood pressure >or=140 mm Hg in general and >or=130 mm Hg in persons with diabetes or chronic kidney disease. Lifestyle intervention may reduce the need for extensive antihypertensive therapy and minimize associated cardiovascular risk factors. To date, only a small percentage of older ISH patients are being treated to goal. Reaching target systolic blood pressure levels most often requires the use of polypharmacy that includes a diuretic and perhaps specific agents that target arterial stiffness and early wave reflection.
有压倒性的证据表明，对单纯收缩期高血压（ISH）（收缩压≥140mmHg且舒张压<90mmHg）进行药物治疗可减少心血管事件并延长老年人的寿命；在高龄老人（80岁及以上）中，证据支持降低中风和心力衰竭的发生率，但在延长寿命方面说服力较弱。因此，ISH血管事件固有的风险增加凸显了控制它的重要性。重要的是，老年人的ISH主要与大动脉僵硬度有关，仍然比年轻人的舒张期高血压更难控制，后者主要与外周血管阻力增加有关。一般来说，收缩压≥140mmHg的个体以及糖尿病或慢性肾脏病患者收缩压≥130mmHg时，均需进行适当的生活方式和药物干预。生活方式干预可能会减少广泛使用降压治疗的需求，并将相关的心血管危险因素降至最低。迄今为止，只有一小部分老年ISH患者得到了达标治疗。达到目标收缩压水平通常需要联合使用多种药物，其中包括利尿剂以及可能针对动脉僵硬度和早期波反射的特定药物。
