Viera Anthony J
Department of Community and Family Medicine Duke University School of Medicine, Box 2914 DUMC, Durham, NC 27710.
FP Essent. 2018 Jun;469:26-29.
Hypertension is prevalent in older adults, and blood pressure (BP) level lowering has been shown to be one of the most important clinical interventions to reduce the risk of cardiovascular events. The goal BP level for older adults is individualized based on age, cardiovascular risk, overall health status (particularly frailty), and patient preferences. Recent guidelines differ but a goal systolic BP level lower than 150 mm Hg is reasonable for nearly all adults 60 years and older. In patients with isolated systolic hypertension, the degree to which systolic BP level lowering can be tolerated may be limited if the diastolic BP level decreases below 60 to 65 mm Hg. Orthostatic hypotension is common among older hypertensive patients. Symptoms of light-headedness should prompt an evaluation for orthostatic hypotension and a possible decrease in drug treatment. For relatively healthy older adults at increased cardiovascular risk, a systolic BP level goal lower than 140 mm Hg may be pursued. Although more aggressive BP level lowering is associated with a greater decrease in the number of cardiovascular events, it also is associated with a higher number of adverse events.
高血压在老年人中很常见，降低血压水平已被证明是降低心血管事件风险的最重要临床干预措施之一。老年人的目标血压水平根据年龄、心血管风险、整体健康状况（尤其是虚弱程度）和患者偏好进行个体化设定。近期的指南有所不同，但对于几乎所有60岁及以上的成年人来说，收缩压目标水平低于150 mmHg是合理的。在单纯收缩期高血压患者中，如果舒张压水平降至60至65 mmHg以下，收缩压降低所能耐受的程度可能会受到限制。体位性低血压在老年高血压患者中很常见。头晕症状应促使对体位性低血压进行评估，并可能减少药物治疗。对于心血管风险增加的相对健康的老年人，可以追求收缩压水平目标低于140 mmHg。虽然更积极地降低血压水平与心血管事件数量的更大减少相关，但也与更高的不良事件数量相关。
