Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy.
Istituti Clinici Scientifici Maugeri- Syncope unit - UOC Cure sub-acute, Milan, Italy.
J Hum Hypertens. 2018 Sep;32(8-9):633-638. doi: 10.1038/s41371-018-0086-6. Epub 2018 Jul 10.
In the last years, guidelines for the treatment of hypertension recommended individualized blood pressure goals for geriatric population because of elderly susceptibility to adverse outcomes and higher mortality rate deriving from the excessive blood pressure lowering, especially in "frail" elderly. Recent findings from the SPRINT study, which demonstrated that intensive blood pressure lowering was associated with lower rates of cardiovascular events and mortality in both hypertensive fit and frail elderly subjects compared to standard treatment, heavily influenced the recent US guidelines. In SPRINT sub-study analysis of adults aged ≥75 years, the most controversial issue appears the method of blood pressure measurement, the selection of patients and related-frailty degree that appears to be very light. Accordingly, it has been described that light frailty is related to good outcomes in older adults. SPRINT findings in "frail elderly patients" cannot be applied to the clinical practice because this condition has been clearly under-estimated. Thus, frailty status should be routinely and correctly quantified in order to identify the frailty degree and to find the best harms-benefits balance of antihypertensive drug treatment in frail older adults.
在过去的几年中，高血压治疗指南建议为老年人群制定个体化的血压目标，因为老年人易发生不良后果，且血压降得过低会导致更高的死亡率，尤其是在“虚弱”的老年人中。SPRINT 研究的最新发现表明，与标准治疗相比，强化降压可降低高血压健康和虚弱老年人的心血管事件和死亡率，这对最近的美国指南产生了重大影响。SPRINT 研究对年龄≥75 岁成年人的亚组分析中，最具争议的问题似乎是血压测量方法、患者选择以及相关的虚弱程度，后者似乎非常轻微。因此，有人描述说轻度虚弱与老年人的良好结局有关。SPRINT 研究在“虚弱老年患者”中的发现不能应用于临床实践，因为这种情况显然被低估了。因此，应常规正确地量化虚弱状态，以确定虚弱程度，并找到在虚弱的老年高血压患者中进行降压药物治疗的最佳利弊平衡。
