Geriatric Intensive Care Unit, Department of Geriatrics, Referral Centre for Hypertension Management in Older Adults, Careggi Hospital and University of Florence, Florence, Italy.
J Hypertens. 2021 Mar 1;39(3):400-407. doi: 10.1097/HJH.0000000000002685.
Hypertension management is challenging in frail older adults. The balance between treatment risks and benefits may be difficult to achieve due to an increased vulnerability to treatment-related adverse events, and limited evidence is available to support clinical decisions. The effects of frailty on blood pressure are unclear, as well as its impact on antihypertensive treatment benefits. Appropriate blood pressure targets in frail patients are debated and the frailty measure which best inform clinical decisions in hypertensive patients has yet to be identified. Therefore, hypertension management in frail older adults still represents a 'gap in evidence'. Knowledge of currently available literature is a fundamental prerequisite to develop future research and may help to implement frailty assessment and improve hypertension management in this vulnerable population. Given these premises, we present a narrative review illustrating the most relevant issues that are a matter of debate and that should be addressed in future studies.
在体弱的老年人中，高血压管理具有挑战性。由于治疗相关不良事件的易感性增加，治疗风险和益处之间的平衡可能难以实现，并且可用的证据有限，无法支持临床决策。虚弱对血压的影响尚不清楚，其对降压治疗益处的影响也不清楚。体弱患者的适当血压目标存在争议，并且尚未确定哪种虚弱测量方法最能为高血压患者的临床决策提供信息。因此，体弱老年人的高血压管理仍然存在“证据空白”。了解当前可用的文献是制定未来研究的基本前提，这可能有助于实施虚弱评估并改善该脆弱人群的高血压管理。基于这些前提，我们进行了叙述性综述，说明了最相关的争议问题，这些问题应在未来的研究中加以解决。
