Odden Michelle C, Beilby Pamela R, Peralta Carmen A
School of Biological and Population Health Sciences, Oregon State University, 141B Milam Hall, Corvallis, OR, 97331, USA,
Curr Hypertens Rep. 2015 Jul;17(7):55. doi: 10.1007/s11906-015-0564-y.
The importance of high blood pressure (BP) and the effect of BP lowering in older adults remain controversial due to the mixed evidence in this population. Frailty status may resolve the apparently conflicting findings and identify subpopulations who share common risk. Emerging evidence demonstrates that low BP is associated with poor outcomes in older frail adults or those with poor functional status. In contrast, in non-frail older adults, low BP appears beneficial. Frail older adults may be at increased risk of hypotension, serious fall injuries, and polypharmacy. Additionally, peripheral BP may not be the best prognostic measure in this population. The majority of clinical practice guidelines give little recommendation for frail older adults, which is likely due to their systematic underrepresentation in randomized controlled trials. Future studies need to consider modifications to safely include frail older adults, and guidelines should consider inclusion of evidence beyond randomized controlled trials.
由于老年人群中的证据相互矛盾，高血压（BP）的重要性以及降低血压在老年人中的效果仍存在争议。虚弱状态可能会解决明显相互矛盾的研究结果，并识别出具有共同风险的亚人群。新出现的证据表明，低血压与老年体弱成年人或功能状态较差的成年人的不良结局相关。相比之下，在非体弱的老年人中，低血压似乎是有益的。体弱的老年人可能发生低血压、严重跌倒损伤和多重用药的风险增加。此外，外周血压可能不是该人群中最佳的预后指标。大多数临床实践指南对体弱的老年人几乎没有给出建议，这可能是因为他们在随机对照试验中的系统性代表性不足。未来的研究需要考虑进行调整，以安全地纳入体弱的老年人，并且指南应考虑纳入随机对照试验以外的证据。
