Aronow Wilbert S
Departments of Cardiology and Medicine, Westchester Medical Center and New York Medical College, Vaslhalla, NY, USA.
Expert Rev Cardiovasc Ther. 2020 Feb;18(2):117-125. doi: 10.1080/14779072.2020.1732206. Epub 2020 Feb 23.
: Hypertension is the leading modifiable risk factor for cardiovascular events and mortality in the world.: An extensive literature review of articles and clinical trials on PUBMED on the topic of hypertension in the elderly from 1976 through January 2020 was conducted. This review article discusses clinical trials on treatment of hypertension in the elderly, the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) hypertension guidelines, the 2018 European Society of Cardiology/European Society of Hypertension guidelines, and the treatment of hypertension and of resistant hypertension in the elderly.: The 2017 ACC/AHA hypertension guidelines recommend treatment of noninstitutionalized ambulatory community-dwelling adults aged 65 years and older with an average systolic blood pressure of 130 mm Hg or higher with lifestyle measures plus antihypertensive drug to lower the blood pressure to less than 130/80 mm Hg. For elderly adults with hypertension and a high burden of comorbidities and limited life expectancy, clinical judgment, patient preference, and a team-based approach to assess risk/benefit is reasonable for decisions about the intensity of SBP lowering and the choice of antihypertensive drugs to use for treatment.
高血压是全球心血管事件和死亡的主要可改变风险因素。对1976年至2020年1月期间发表在PUBMED上关于老年高血压主题的文章和临床试验进行了广泛的文献综述。这篇综述文章讨论了老年高血压治疗的临床试验、2017年美国心脏病学会（ACC）/美国心脏协会（AHA）高血压指南、2018年欧洲心脏病学会/欧洲高血压学会指南，以及老年高血压和顽固性高血压的治疗。2017年ACC/AHA高血压指南建议，对于年龄在65岁及以上、平均收缩压为130 mmHg或更高的非机构化社区居住成年人，采用生活方式干预加降压药物治疗，将血压降至低于130/80 mmHg。对于患有高血压且合并症负担高、预期寿命有限的老年成年人，临床判断、患者偏好以及基于团队的方法来评估风险/获益对于决定收缩压降低的强度和选择用于治疗的降压药物是合理的。
