Renal, Electrolyte and Hypertension Division, University of Pennsylvania, Philadelphia, USA.
Curr Hypertens Rep. 2011 Oct;13(5):330-7. doi: 10.1007/s11906-011-0215-x.
Hypertension is common in the elderly, and its prevalence increases with aging. The vascular system is a prototypical aging tissue, and arterial stiffness plays a major role in hypertension as the individual ages. Some unique aging changes in the nitric oxide and angiotensin II pathways are particularly important for vascular aging. Studies focusing on direct measures of vascular stiffness have increased understanding of the pathophysiology behind increased arterial stiffness. Goal blood pressure in the elderly is debated, but based on current outcome data, a goal blood pressure of 150/80-90 mm Hg is reasonable in at least the very elderly. This review discusses in detail the various landmark hypertension studies in the elderly. We recommend use of thiazide diuretics, long-acting calcium channel blockers, and angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers as either monotherapy or in combination, with beta-blockers reserved for patients with specific indications.
高血压在老年人中很常见，其患病率随着年龄的增长而增加。血管系统是典型的衰老组织，随着个体年龄的增长，动脉僵硬度在高血压中起着重要作用。一氧化氮和血管紧张素 II 途径中的一些独特的衰老变化对血管衰老尤为重要。关注血管僵硬度的直接测量方法的研究增加了对动脉僵硬度增加背后病理生理学的理解。老年患者的目标血压存在争议，但基于目前的结果数据，至少对于非常高龄的患者，将目标血压设定为 150/80-90mmHg 是合理的。这篇综述详细讨论了老年人中的各种标志性高血压研究。我们建议使用噻嗪类利尿剂、长效钙通道阻滞剂和血管紧张素转换酶抑制剂或血管紧张素 II 受体阻滞剂作为单一疗法或联合疗法，将β受体阻滞剂保留给有特定适应证的患者。
