Krane N K, Wallin J D
Geriatrics. 1987 Apr;42(4):45-9, 52.
Older patients with both hypertension and pulmonary disease pose a challenge to the physician. Satisfactory blood-pressure control must be achieved without exacerbating the concomitant pulmonary disease. Diuretics may interfere with mucus production and cause acid-base and electrolyte abnormalities. The beta-adrenergic blocking agents should be avoided because of their risk of inducing bronchospasm. If a beta blocker must be used, it should be combined with an alpha- and beta-adrenergic blocker, or an agent with intrinsic sympathomimetic activity or beta 1 selectivity. The direct and indirect vasodilators may be used safely in these patients, but the risk of worsening any underlying coronary artery disease must be kept in mind when prescribing either hydralazine or minoxidil. The calcium channel blockers and ACE-inhibitors have the best safety record in treating the elderly who have hypertension and COPD. For these patients, the calcium channel blockers offer the advantage of simultaneous therapy of coronary artery disease, whereas hypertensive patients with congestive heart failure would be more likely to benefit from an ACE-inhibitor. The ability to treat hypertension without precipitating unwanted adverse reactions or dangerous side effects is one of the arts of medicine. Fortunately, the range of drugs available to today's physician allows safe and efficacious treatment of the elderly patient who has both hypertension and pulmonary disease.
患有高血压和肺部疾病的老年患者给医生带来了挑战。必须在不加重并发肺部疾病的情况下实现满意的血压控制。利尿剂可能会干扰黏液分泌，并导致酸碱和电解质异常。应避免使用β-肾上腺素能阻滞剂，因为它们有诱发支气管痉挛的风险。如果必须使用β受体阻滞剂，应将其与α和β肾上腺素能阻滞剂、或具有内在拟交感活性或β1选择性的药物联合使用。直接和间接血管扩张剂可在这些患者中安全使用，但在开肼屈嗪或米诺地尔时，必须牢记加重任何潜在冠状动脉疾病的风险。钙通道阻滞剂和ACE抑制剂在治疗患有高血压和慢性阻塞性肺疾病的老年人方面具有最佳的安全记录。对于这些患者，钙通道阻滞剂具有同时治疗冠状动脉疾病的优势，而患有充血性心力衰竭的高血压患者更可能从ACE抑制剂中获益。在不引发不良不良反应或危险副作用的情况下治疗高血压的能力是医学的一门艺术。幸运的是，当今医生可获得的药物范围允许对患有高血压和肺部疾病的老年患者进行安全有效的治疗。
