Fritschka E, Distler A
Fortschr Med. 1989 Oct 30;107(31):662-6.
Previous studies carried out on the treatment of hypertension in the elderly patient indicate that, in this group of patients, antihypertensive treatment can reduce cardiovascular mortality mainly by reducing mortality from cerebrovascular diseases. To date, the success of hypertensive treatment in over-80-year-olds with uncomplicated hypertension, and patients with isolated systolic hypertension, has not been documented. In the treatment of the elderly patient, age-specific pathophysiological changes need to be taken into account. Such changes are deteriorating renal performance, increased vasoconstriction, decreasing baroreceptor function, declining cardiac performance, and changes in the autoregulation of cerebral blood flow. For this reason, in geriatric hypertensives, the blood pressure should be reduced gradually over a period of weeks. Antihypertensive drugs with a natriuretic or vasodilative effect are pathophysiologically meaningful, while substances that result in a loss of potassium, depression of the sympathetic nervous system and negative inotropism are not so favorable.
以往针对老年患者高血压治疗的研究表明，在这类患者中，降压治疗主要通过降低脑血管疾病死亡率来降低心血管死亡率。迄今为止，80岁以上单纯性高血压患者及单纯收缩期高血压患者的降压治疗效果尚无文献记载。在老年患者的治疗中，需要考虑特定年龄的病理生理变化。这些变化包括肾功能恶化、血管收缩增强、压力感受器功能减退、心脏功能下降以及脑血流自动调节功能改变。因此，对于老年高血压患者，血压应在数周内逐渐降低。具有利钠或血管舒张作用的降压药物在病理生理上是有意义的，而导致钾流失、抑制交感神经系统和负性肌力作用的药物则不太适宜。
