Faubert P F, Porush J G
Geriatrics. 1987 Jan;42(1):49-51, 55-8.
Hypertension is very common in the elderly patient with renal insufficiency and may be primary or secondary to the kidney disease. In these patients, hypertension is usually associated with an increase in peripheral vascular resistance and salt sensitivity (the latter related to the degree of renal failure.) Therapy should be tailored to the individual patient, particularly when the elevated blood pressure and renal insufficiency are associated with other significant medical problems. Most of the drugs used in younger hypertensives may be used in the elderly patient with renal insufficiency, but in general, starting and maintenance doses should be lower because of the greater sensitivity due to age and/or the renal failure. The goal in the elderly hypertensive patient with renal failure is similar to that in other hypertensive patients: blood pressure should be brought to 140/90 mm Hg or lower. In the elderly patient with resistant hypertension or who manifests a decrease in kidney function as blood pressure is lowered, an effort must be made to look for associated renovascular disease.
高血压在老年肾功能不全患者中非常常见，可能是原发性的，也可能继发于肾脏疾病。在这些患者中，高血压通常与外周血管阻力增加和盐敏感性增加有关（后者与肾衰竭程度有关）。治疗应根据个体患者进行调整，尤其是当血压升高和肾功能不全与其他严重医疗问题相关时。大多数用于年轻高血压患者的药物也可用于老年肾功能不全患者，但一般来说，由于年龄和/或肾衰竭导致的敏感性更高，起始剂量和维持剂量应更低。老年肾衰竭高血压患者的治疗目标与其他高血压患者相似：血压应降至140/90 mmHg或更低。对于老年顽固性高血压患者或血压降低时肾功能出现下降的患者，必须努力寻找相关的肾血管疾病。
