From Veterans Affairs Portland Health Care System and Oregon Health & Science University, Portland, Oregon.
Ann Intern Med. 2017 Mar 21;166(6):419-429. doi: 10.7326/M16-1754. Epub 2017 Jan 17.
Recent guidelines recommend a systolic blood pressure (SBP) goal of less than 150 mm Hg for adults aged 60 years or older, but the balance of benefits and harms is unclear in light of newer evidence.
To systematically review the effects of more versus less intensive BP control in older adults.
Multiple databases through January 2015 and MEDLINE to September 2016.
21 randomized, controlled trials comparing BP targets or treatment intensity, and 3 observational studies that assessed harms.
Two investigators extracted data, assessed study quality, and graded the evidence using published criteria.
Nine trials provided high-strength evidence that BP control to less than 150/90 mm Hg reduces mortality (relative risk [RR], 0.90 [95% CI, 0.83 to 0.98]), cardiac events (RR, 0.77 [CI, 0.68 to 0.89]), and stroke (RR, 0.74 [CI, 0.65 to 0.84]). Six trials yielded low- to moderate-strength evidence that lower targets (≤140/85 mm Hg) are associated with marginally significant decreases in cardiac events (RR, 0.82 [CI, 0.64 to 1.00]) and stroke (RR, 0.79 [CI, 0.59 to 0.99]) and nonsignificantly fewer deaths (RR, 0.86 [CI, 0.69 to 1.06]). Low- to moderate-strength evidence showed that lower BP targets do not increase falls or cognitive impairment.
Data relevant to frail elderly adults and the effect of multimorbidity are limited.
Treatment to at least current guideline standards for BP (<150/90 mm Hg) substantially improves health outcomes in older adults. There is less consistent evidence, largely from 1 trial targeting SBP less than 120 mm Hg, that lower BP targets are beneficial for high-risk patients. Lower BP targets did not increase falls or cognitive decline but are associated with hypotension, syncope, and greater medication burden.
U.S. Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Quality Enhancement Research Initiative. (PROSPERO 2015: CRD42015017677).
最近的指南建议，60 岁及以上成年人的收缩压（SBP）目标应低于 150mmHg，但鉴于新证据，其益处和危害的平衡尚不清楚。
系统回顾更积极与不太积极的血压控制对老年人的影响。
2015 年 1 月前的多个数据库和 2016 年 9 月前的 MEDLINE。
21 项比较血压目标或治疗强度的随机对照试验，以及 3 项评估危害的观察性研究。
两名研究者提取数据、评估研究质量，并使用已发表的标准评估证据等级。
9 项试验提供了强有力的证据表明，将血压控制在 150/90mmHg 以下可降低死亡率（相对风险 [RR]，0.90 [95%CI，0.83 至 0.98]）、心脏事件（RR，0.77 [CI，0.68 至 0.89]）和卒中（RR，0.74 [CI，0.65 至 0.84]）。6 项试验提供了低至中强度的证据表明，较低的目标值（≤140/85mmHg）与心脏事件（RR，0.82 [CI，0.64 至 1.00]）和卒中（RR，0.79 [CI，0.59 至 0.99]）发生率略有显著降低以及死亡率无显著降低（RR，0.86 [CI，0.69 至 1.06]）相关。低至中强度的证据表明，较低的血压目标不会增加跌倒或认知障碍。
与体弱老年人以及多种合并症的影响相关的数据有限。
治疗血压至少达到当前指南标准（<150/90mmHg）可显著改善老年人的健康结局。对于高危患者，较低的血压目标值是否有益，证据尚不充分，主要来自一项 SBP 目标值<120mmHg 的试验。较低的血压目标值不会增加跌倒或认知下降，但与低血压、晕厥和更大的药物负担相关。
美国退伍军人事务部，退伍军人健康管理局，研究与发展办公室，质量增强研究倡议。（PROSPERO 2015：CRD42015017677）
