Department of Internal Medicine, University of Pisa, Pisa, Italy.
Curr Pharm Des. 2011;17(28):3020-31. doi: 10.2174/138161211798157711.
The progressive ageing of world population, and the increasing prevalence hypertension in elderly people are leading to the consideration that hypertension in the elderly is one of the main topic in hypertension treatment. Multiple mechanisms, including stiffening of large arteries, endothelial dysfunction, cardiac remodeling, autonomic dysregulation, renal aspects, contribute to the great prevalence of hypertension in the elderly and to increased cardiovascular morbidity and mortality. Treatment of hypertension can hardly put back older patients in a low risk category, especially if target organ damage is present. Nevertheless, blood pressure control can successfully prevent stroke, cognitive decline, coronary heart disease and heart failure, and reduce mortality in the elderly, and even in patients > 80 years, as recently demonstrated. Blood pressure should be lowered below 140/90 mmHg also in older patients. However the HYVET study suggests that a goal of 150/90 mmHg can be reasonable in patients aged 80 years or more. Drug treatment should be titrated with particular caution to adverse responses and excessive blood pressure lowering.
世界人口的老龄化进程不断推进，老年人高血压的患病率也不断增加，这使得人们开始考虑老年人高血压是高血压治疗的主要课题之一。多种机制，包括大动脉僵硬、内皮功能障碍、心脏重构、自主神经调节异常、肾脏方面等，导致老年人高血压的高发，并增加心血管发病率和死亡率。治疗高血压几乎不可能使老年患者的风险降低到低水平，尤其是在存在靶器官损害的情况下。然而，正如最近所证明的那样，血压控制可以成功预防老年人发生中风、认知能力下降、冠心病和心力衰竭，并降低死亡率，甚至在>80 岁的患者中也是如此。即使是老年患者，血压也应降至 140/90mmHg 以下。然而，HYVET 研究表明，对于 80 岁或以上的患者，150/90mmHg 的目标可能是合理的。药物治疗应特别谨慎地调整剂量，以避免不良反应和过度降压。
