Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China.
Chin Med J (Engl). 2017 Aug 20;130(16):1968-1972. doi: 10.4103/0366-6999.211885.
Hypertension is an important risk factor of cardiovascular disease and increases mortality in the elderly. However, the available medical evidences are both inconsistent and insufficient regarding establishing credible and useful blood pressure (BP) targets in the hypertensive elderly. This review summarizes the existing evidences used for establishing optimal BP targets for this patient population and points out some data inconsistencies which have added to the uncertainty.
We conducted a search for the articles published in English in the PubMed database up to March 2017, with the keywords "hypertension," "elderly," "blood pressure," and "antihypertensive."
Articles that related to BP targeting in the hypertensive elderly were selected for this review.
The selected studies indicated that antihypertensive therapy can substantially reduce the risk of cardiovascular events and mortality, for a subset of the elderly (60 years or older) with systolic BP> 160 mmHg. Studies regarding more strict targets yielded mixed findings. For the very old and frail patients (80 years or older), there is a lack of evidence that optimal BP targets and intensive antihypertensives are helpful but in fact may be harmful.
There are solid evidences that patients who are 60-80 years old and in good health have benefited from lowering their BP to below 150/90 mmHg. If well tolerated, the BP target can be further lowered to below 140/90 mmHg. However, for the very old and frail, individualized and careful assessment is crucial. Antihypertensive treatment should be cautious and the adverse effect of drugs requires close monitoring as such treatment can be counterproductive.
高血压是心血管疾病的重要危险因素，会增加老年人的死亡率。然而，对于高血压老年人，建立可信且有用的血压（BP）目标的现有医学证据既不一致，也不充分。本综述总结了用于为该患者人群确定最佳 BP 目标的现有证据，并指出了一些增加不确定性的数据不一致性。
我们在 PubMed 数据库中以英文搜索了截至 2017 年 3 月发表的文章，关键词为“高血压”、“老年人”、“血压”和“抗高血压”。
选择了与高血压老年人的 BP 目标相关的文章进行综述。
所选研究表明，对于部分（60 岁及以上）收缩压>160mmHg 的老年人，抗高血压治疗可显著降低心血管事件和死亡率的风险。针对更严格目标的研究得出的结果不一致。对于非常年老和体弱的患者（80 岁及以上），缺乏最佳 BP 目标和强化抗高血压治疗有帮助的证据，但实际上可能有害。
有确凿的证据表明，年龄在 60-80 岁且健康状况良好的患者从将血压降低到<150/90mmHg 以下中受益。如果耐受良好，可以进一步将血压目标降低到<140/90mmHg 以下。然而，对于非常年老和体弱的患者，个体化和仔细评估至关重要。抗高血压治疗应谨慎，药物的不良反应需要密切监测，因为这种治疗可能适得其反。
