Uchmanowicz Izabella, Chudiak Anna, Jankowska-Polańska Beata, Gobbens Robbert
Division of Nursing in Internal Medicine Procedures, Department of Clinical Nursing, The Faculty of Health Sciences,Wroclaw Medical University, Poland.
The Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences,Amsterdam, the Netherlands.
Card Fail Rev. 2017 Nov;3(2):102-107. doi: 10.15420/cfr.2017:9:2.
Hypertension is both a health problem and a financial one globally. It affects nearly 30 % of the general population. Elderly people, aged ≥65 years, are a special group of hypertensive patients. In this group, the overall prevalence of the disease reaches 60 %, rising to 70 % in those aged ≥80 years. In the elderly population, isolated systolic hypertension is quite common. High systolic blood pressure is associated with an increased risk of cardiovascular disease, cerebrovascular disease, peripheral artery disease, cognitive impairment and kidney disease. Considering the physiological changes resulting from ageing alongside multiple comorbidities, treatment of hypertension in elderly patients poses a significant challenge to treatment teams. Progressive disability with regard to the activities of daily life, more frequent hospitalisations and low quality of life are often seen in elderly patients. There is discussion in the literature regarding frailty syndrome associated with old age. Frailty is understood to involve decreased resistance to stressors, depleted adaptive and physiological reserves of a number of organs, endocrine dysregulation and immune dysfunction. The primary dilemma concerning frailty is whether it should only be defined on the basis of physical factors, or whether psychological and social factors should also be included. Proper nutrition and motor rehabilitation should be prioritised in care for frail patients. The risk of orthostatic hypotension is a significant issue in elderly patients. It results from an autonomic nervous system dysfunction and involves maladjustment of the cardiovascular system to sudden changes in the position of the body. Other significant issues in elderly patients include polypharmacy, increased risk of falls and cognitive impairment. Chronic diseases, including hypertension, deteriorate baroreceptor function and result in irreversible changes in cerebral and coronary circulation. Concurrent frailty or other components of geriatric syndrome in elderly patients are associated with a worse perception of health, an increased number of comorbidities and social isolation of the patient. It may also interfere with treatment adherence. Identifying causes of non-adherence to pharmaceutical treatment is a key factor in planning therapeutic interventions aimed at increasing control, preventing complications, and improving long-term outcomes and any adverse effects of treatment. Diagnosis of frailty and awareness of the associated difficulties in adhering to treatment may allow targeting of those elderly patients who have a poorer prognosis or may be at risk of complications from untreated or undertreated hypertension, and for the planning of interventions to improve hypertension control.
高血压在全球范围内既是一个健康问题，也是一个经济问题。它影响着近30%的普通人群。65岁及以上的老年人是高血压患者中的一个特殊群体。在这个群体中，该病的总体患病率达到60%，80岁及以上者升至70%。在老年人群中，单纯收缩期高血压相当常见。收缩压升高与心血管疾病、脑血管疾病、外周动脉疾病、认知障碍和肾脏疾病的风险增加相关。考虑到衰老引起的生理变化以及多种合并症，老年患者的高血压治疗对治疗团队构成了重大挑战。老年患者日常生活活动能力逐渐丧失、住院频率增加以及生活质量低下的情况屡见不鲜。文献中对与老年相关的衰弱综合征存在讨论。衰弱被认为涉及对应激源的抵抗力下降、多个器官的适应性和生理储备耗尽、内分泌失调以及免疫功能障碍。关于衰弱的主要困境在于，它是否仅应基于身体因素来定义，还是也应纳入心理和社会因素。对于衰弱患者的护理，应优先考虑适当的营养和运动康复。体位性低血压风险在老年患者中是一个重要问题。它由自主神经系统功能障碍引起，涉及心血管系统对身体位置突然变化的调节失调。老年患者中的其他重要问题包括多重用药、跌倒风险增加和认知障碍。包括高血压在内的慢性疾病会使压力感受器功能恶化，并导致脑循环和冠状动脉循环发生不可逆变化。老年患者并发衰弱或老年综合征的其他组成部分与对健康状况的更差认知、更多合并症以及患者的社会隔离相关。这也可能干扰治疗依从性。确定药物治疗不依从的原因是规划旨在提高控制率、预防并发症以及改善长期结局和治疗任何不良反应的治疗干预措施的关键因素。衰弱的诊断以及对治疗依从性相关困难的认识，可能有助于针对那些预后较差或可能因高血压未治疗或治疗不足而有并发症风险的老年患者，并有助于规划改善高血压控制的干预措施。
