Aronow Wilbert S
Divisions of Cardiology, Geriatrics, and Pulmonary/Critical Care, New York Medical College, Westchester Medical Center/New York Medical College, Valhalla, NY, USA.
Geriatrics. 2008 Oct;63(10):21-5.
Numerous double-blind, randomized, placebo-controlled studies have shown that antihypertensive drug therapy reduces cardiovascular events in elderly persons. In the Hypertension in the Very Elderly Trial, patients aged 80 years and older treated with antihypertensive drug therapy had, at 1.8-year follow-up, a 30 percent reduction in fatal or nonfatal stroke, a 39 percent reduction in fatal stroke, a 21 percent reduction in all-cause mortality, a 23 percent reduction in death from cardiovascular causes, and a 64 percent reduction in heart failure. The goal of treatment of hypertension in elderly persons is to lower the blood pressure to less than 140/90 mmHg and to less than 130/80 mmHg in older persons with diabetes or chronic renal insufficiency. All antihypertensive drugs may predispose the elderly person to develop symptomatic orthostatic hypotension and postprandial hypotension and syncope or falls. Adverse effects depend upon the antihypertensive drugs used, the doses of these drugs, the comorbidities in the elderly patients taking these drugs, and drug-drug interactions.
大量双盲、随机、安慰剂对照研究表明，抗高血压药物治疗可降低老年人的心血管事件。在高龄老人高血压试验中，接受抗高血压药物治疗的80岁及以上患者，在1.8年的随访中，致命或非致命性卒中减少30%，致命性卒中减少39%，全因死亡率降低21%，心血管原因导致的死亡降低23%，心力衰竭降低64%。老年高血压患者的治疗目标是将血压降至低于140/90 mmHg，对于患有糖尿病或慢性肾功能不全的老年人，血压应降至低于130/80 mmHg。所有抗高血压药物都可能使老年人易发生症状性体位性低血压、餐后低血压以及晕厥或跌倒。不良反应取决于所用的抗高血压药物、这些药物的剂量、服用这些药物的老年患者的合并症以及药物相互作用。
