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关于老年高血压患者治疗方案的思考

[Considerations about treatment programs of elderly patients with hypertension].

作者信息

Li Hao, Liu Long-tao

机构信息

Department of Geriatrics, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, China.

出版信息

Zhong Xi Yi Jie He Xue Bao. 2009 Jul;7(7):607-10. doi: 10.3736/jcim20090702.

Abstract

Hypertension in elderly patients is a common and frequent disease which could cause stroke, heart failure and renal dysfunction. The pathogenesis of hypertension in the elderly is different from that in the young and middle-aged people, and its clinical characteristics including frequent isolated systolic hypertension, variable blood pressure, high pulse pressure, multiple complications, serious target organ damage, and so on. High prevalence, disability and mortality rates and low awareness, treatment and control rates are prominent phenomena in the elderly patients with hypertension, bringing many difficulties for clinical treatment. Presently, drug therapies for elderly patients mainly include Western medicine (WM), traditional Chinese medicine (TCM), and integrated traditional Chinese and Western medicine. WM therapy has superiority in lowering blood pressure intensively with clear mechanism, but has more adverse reactions. The effects of TCM therapy are multilinked, and TCM is good at reducing side effects and improving symptoms, but TCM preparation falls behind and its hypotensive effects are weak and slow. Furthermore, more multicenter, randomized, controlled and double-blinded clinical trials with large sample are needed to identify the effects of TCM therapy. Based on combination of TCM syndrome differentiation and WM disease differentiation, treatment programs of integrated traditional Chinese and Western medicine would take advantages of both TCM and WM treatment modalities, and are worthy of being studied in the future.

摘要

老年高血压是一种常见且多发的疾病,可导致中风、心力衰竭和肾功能不全。老年高血压的发病机制与中青年不同,其临床特点包括单纯收缩期高血压常见、血压波动大、脉压高、并发症多、靶器官损害严重等。老年高血压患者中患病率、致残率和死亡率高,知晓率、治疗率和控制率低是突出现象,给临床治疗带来诸多困难。目前,老年患者的药物治疗主要包括西药、中药和中西医结合治疗。西药治疗在强效降压方面具有优势,机制明确,但不良反应较多。中药治疗作用多环节,善于减轻副作用和改善症状,但中药制剂落后,降压作用弱且缓慢。此外,需要更多多中心、随机、对照、大样本双盲临床试验来明确中药治疗的效果。基于中医辨证与西医辨病相结合,中西医结合治疗方案将发挥中医和西医治疗方式的优势,值得未来深入研究。

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