Imperial Syncope Unit, Imperial College Healthcare NHS Trust, London W12 0HS, UK.
Cutrale Peri-operative and Ageing group, Department of Bioengineering, Imperial College London, London W12 0BZ, UK.
Age Ageing. 2022 Aug 2;51(8). doi: 10.1093/ageing/afac150.
Blood pressure regulation is an automatic, moment-by-moment buffering of the blood pressure in response to physiological changes such as orthostasis, exercise and haemorrhage. This finely orchestrated reflex is called the baroreflex. It is a regulated arc of afferent, central and efferent arms. Multiple physiological changes occur with ageing that can disrupt this reflex, making blood pressure regulation less effective. In addition, multiple changes can occur with ageing-related diseases such as neurodegeneration, atherosclerosis, deconditioning and polypharmacy. These changes commonly result in orthostatic hypotension, hypertension or both, and are consistently associated with multiple adverse outcomes. In this article, we discuss the healthy baroreflex, and physiological and pathophysiological reasons for impaired baroreflex function in older people. We discuss why the common clinical manifestations of orthostatic hypotension and concomitant supine hypertension occur, and strategies for balancing these conflicting priorities. Finally, we discuss strategies for treating them, outlining our practice alongside consensus and expert guidance.
血压调节是一种自动的、即时的血压缓冲，以响应生理变化，如直立位、运动和出血。这种精细协调的反射称为压力反射。它是一个受调节的传入、中枢和传出臂的弧。随着年龄的增长，会发生多种生理变化，从而破坏这种反射，使血压调节效果降低。此外，与年龄相关的疾病（如神经退行性疾病、动脉粥样硬化、失能和多药治疗）也会发生多种变化。这些变化通常导致直立性低血压、高血压或两者兼而有之，并与多种不良后果一致相关。在本文中，我们讨论了健康的压力反射，以及老年人压力反射功能受损的生理和病理生理原因。我们讨论了为什么常见的直立性低血压和仰卧位高血压的临床表现同时发生，以及平衡这些相互冲突的优先事项的策略。最后，我们讨论了治疗这些疾病的策略，概述了我们的实践以及共识和专家指导。
