Division of Cardiology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
Hypertens Res. 2023 May;46(5):1188-1194. doi: 10.1038/s41440-023-01200-6. Epub 2023 Feb 15.
Frailty is a state of increased vulnerability to stress resulting from physiological decline associated with aging. Topics of hypertension management and its association with frailty and cognitive function, recent studies of coronavirus disease 2019 infection (COVID-19) in elderly is discussed in this narrative review. While various guidelines for hypertension recommend that frailty is taken into account in treatment decisions, specific assessment tools and clinical decision criteria have not been explicitly established. Hypertension is prevalent in frail individuals, although a direct association has not been reported. Therefore, optimal blood pressure (BP) control is critical for managing cardiovascular risk reduction and preserving quality of life in frail hypertensive patients. BP typically decreases in later life or situations in which patients are dependent on nursing care. Mortality is reported to be high among frail patients with lower BP, raising questions about appropriate BP targets for frail patients. Cognitive decline is one of the domains of frailty, and is associated with a loss of autonomy, lack of self-management, and compromised quality of life. It remains to be clarified whether antihypertensive treatment is beneficial for cognitive function especially in older individuals. Increased severity and mortality of COVID-19 infection has been reported in older people. Clinical manifestations and biomarkers particular to older patients, and lifestyle changes including social isolation during the COVID-19 pandemic is reported. From the knowledge from recent literatures, future perspectives for holistic approach and management of frail older people is addressed.
衰弱是一种由于与衰老相关的生理衰退而导致对压力更加敏感的状态。本叙述性综述讨论了高血压管理及其与衰弱和认知功能的关系，以及最近关于老年人 2019 年冠状病毒病（COVID-19）感染的研究。虽然各种高血压管理指南建议在治疗决策中考虑衰弱状况，但尚未明确制定具体的评估工具和临床决策标准。衰弱个体中高血压很常见，尽管尚未报道直接相关性。因此，对于衰弱的高血压患者，优化血压（BP）控制对于降低心血管风险和维持生活质量至关重要。BP 通常在生命后期或患者依赖护理的情况下下降。据报道，BP 较低的衰弱患者死亡率较高，这引发了对衰弱患者适当 BP 目标的质疑。认知衰退是衰弱的一个领域，与自主能力丧失、自我管理不足和生活质量受损有关。抗高血压治疗是否对认知功能有益，特别是在老年人中，仍有待阐明。据报道，老年人 COVID-19 感染的严重程度和死亡率更高。报道了与老年人有关的临床表现和生物标志物，以及包括 COVID-19 大流行期间社会隔离在内的生活方式改变。根据最近文献的知识，解决了衰弱老年人整体方法和管理的未来展望。
