Department of Pharmacy Practice, University of Rhode Island, Kingston, RI, USA.
Ann Pharmacother. 2011 Sep;45(9):1138-43. doi: 10.1345/aph.1P791. Epub 2011 Aug 18.
To review the evidence for strict blood pressure (BP) management in the very elderly, defined as patients aged 80 years and older.
A literature search was performed using PubMed (1950 through November 2010) for the MeSH terms hypertension and elderly; subterms of identified MeSH terms (ie, explosion) for the elderly were also searched. A broader search was conducted of PubMed articles published in the past 4 years. Searches were conducted for additional primary literature referenced in identified articles; an updated Cochrane Database review was also performed.
All identified studies that specifically included very elderly patients and BP were reviewed.
The BP goal established in the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) is less than 140/90 mm Hg, regardless of age, unless a compelling indication exists. Although evidence suggests that lowering BP will lower the risk of stroke, lower BP in the very elderly may result in higher mortality. Many physicians are reluctant to treat BP in accordance with the JNC 7 goal in very elderly patients for a variety of reasons, including concerns about fall risk, lack of benefit in mortality reduction, and concerns about drug interactions and adverse effects. Results from a randomized controlled trial and meta-analysis have demonstrated reductions in stroke, heart failure, and cardiovascular events in the very elderly. The American College of Cardiology Foundation/American Heart Association recently published guidelines for elderly patients that suggest treating the very elderly carefully and with different BP goals than previously recommended.
Optimal management of hypertension in the very elderly remains a concern. Few studies have evaluated hypertension in this population, and studies that included patients over 80 enrolled too few to draw conclusions. Although the HYVET (Hypertension in the Very Elderly Trial) study did have adequate power to evaluate the very elderly, because this study was stopped early because of significant findings in mortality, unanswered questions remain regarding optimal BP targets.
回顾高龄患者（定义为 80 岁及以上的患者）血压严格管理的证据。
使用 PubMed（1950 年至 2010 年 11 月）的 MeSH 术语“高血压”和“老年人”进行文献检索；还搜索了确定的 MeSH 术语的子项（即“爆炸”）的老年人。还对过去 4 年发表的 PubMed 文章进行了更广泛的搜索。对确定文章中引用的其他主要文献进行了额外的初级文献搜索；还对更新的 Cochrane 数据库综述进行了检索。
对专门纳入高龄患者和血压的所有确定研究进行了综述。
第七次联合国家委员会预防、检测、评估和治疗高血压报告（JNC 7）中确定的血压目标值低于 140/90mmHg，无论年龄大小，除非存在强烈的适应证。尽管有证据表明降低血压会降低中风风险，但在高龄患者中降低血压可能会导致更高的死亡率。许多医生由于各种原因不愿按照 JNC 7 的目标治疗高龄患者的血压，包括对跌倒风险的担忧、死亡率降低方面的益处不足、以及对药物相互作用和不良反应的担忧。一项随机对照试验和荟萃分析的结果表明，在高龄患者中降低了中风、心力衰竭和心血管事件的风险。美国心脏病学会基金会/美国心脏协会最近发布了老年患者指南，建议谨慎治疗高龄患者，并采用与之前推荐不同的血压目标值。
高龄患者高血压的最佳管理仍然令人关注。很少有研究评估该人群的高血压，包括 80 岁以上患者的研究纳入的患者太少，无法得出结论。尽管 HYVET（非常高龄患者高血压试验）研究有足够的能力评估高龄患者，但由于该研究因死亡率方面的显著发现而提前停止，因此关于最佳血压目标仍存在未解答的问题。
