Neutel Joel M, Gilderman Lawrence I
Orange County Research Center, Tustin, CA 92780, USA.
J Clin Hypertens (Greenwich). 2008 Jan;10(1 Suppl 1):33-9. doi: 10.1111/j.1524-6175.2007.08030.x.
Hypertension is highly prevalent in older persons and most often presents as isolated systolic hypertension. Systolic blood pressure (BP) is a stronger predictor of risk than diastolic BP in persons older than 50 years. Most of these patients will require multiple drug therapies to achieve the substantial reductions in systolic BP needed to reach target levels. Clinical trials have demonstrated that antihypertensive therapy with beta-blockers and diuretics as well as with calcium channel blockers, angiotensin-converting enzyme inhibitors, and angiotensin II type 1 receptor blockers reduces cardiovascular risk in older patients. Studies examining safety and BP-lowering efficacy have shown that a renin-angiotensin-aldosterone system blocker plus a calcium channel blocker as well as a combination of diuretics and beta-blockers or diuretics plus an angiotensin-converting enzyme inhibitor or angiotensin II type 1 receptor blocker achieves greater BP reductions than monotherapy. Such multiple drug regimens are well tolerated in older patients.
高血压在老年人中非常普遍，且最常表现为单纯收缩期高血压。在50岁以上人群中，收缩压比舒张压更能预测风险。这些患者中的大多数需要多种药物治疗，才能大幅降低收缩压以达到目标水平。临床试验表明，使用β受体阻滞剂、利尿剂以及钙通道阻滞剂、血管紧张素转换酶抑制剂和血管紧张素II 1型受体阻滞剂进行抗高血压治疗可降低老年患者的心血管风险。研究安全性和降压疗效的结果显示，肾素-血管紧张素-醛固酮系统阻滞剂加钙通道阻滞剂以及利尿剂与β受体阻滞剂联合使用，或利尿剂加血管紧张素转换酶抑制剂或血管紧张素II 1型受体阻滞剂，比单一疗法能更大程度地降低血压。老年患者对这种多药联合方案耐受性良好。
