The Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
Hypertens Res. 2023 Aug;46(8):1917-1922. doi: 10.1038/s41440-023-01310-1. Epub 2023 Jun 6.
The significance of hypertension management in older individuals is greatly influenced by factors other than chronological age, as they have diverse physical, mental, and social backgrounds. Differences in physical functions, between independence, frailty and dependence, have a great impact on antihypertensive therapy in the older population. While recent clinical trials support the significance of intensive antihypertensive therapy regardless of age, there is little evidence to positively support the significance of antihypertensive therapy for older patients with physical function requiring nursing care, and observational studies suggest that antihypertensive treatment may instead be harmful in these older patients. Therefore, frailty, the transitional state between independence and dependence with the need for nursing care, is conceivable to be the tipping point at which the balance of risks and benefits of antihypertensive treatment is converted. The increased risk of acute adverse outcome is another issue that complicates management in the practice of hypertension treatment in frail patients. Particularly, increased blood pressure variability manifested by orthostatic hypotension in frail patients can induce fall and fracture leading to disability shortly after initiation or modification of antihypertensive treatment. Future challenges to optimize the management of frail hypertensive patients include developing techniques to estimate treatment efficacy, identifying safe antihypertensive regimens that reduce the risk of falls, and establishing strategies to restore frail patients to robust health.
高血压管理在老年人中的意义不仅受年龄因素的影响，还受到其生理、心理和社会背景的影响。身体功能的差异，包括独立、虚弱和依赖之间的差异，对老年人群的降压治疗有很大影响。虽然最近的临床试验支持无论年龄大小，强化降压治疗的重要性，但几乎没有证据能积极支持对需要护理的身体功能的老年患者进行降压治疗的重要性，观察性研究表明，降压治疗可能对这些老年患者有害。因此，可以想象，虚弱是独立和依赖之间需要护理的过渡状态，是降压治疗的风险和益处平衡发生转变的临界点。急性不良结局风险增加是另一个使脆弱患者高血压治疗管理复杂化的问题。特别是，虚弱患者体位性低血压表现出的血压变异性增加可能导致降压治疗开始或调整后不久发生跌倒和骨折，导致残疾。优化脆弱高血压患者管理的未来挑战包括开发估计治疗效果的技术、确定降低跌倒风险的安全降压方案以及制定使脆弱患者恢复健康的策略。
