Departmentof Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
J Korean Med Sci. 2024 Mar 18;39(10):e84. doi: 10.3346/jkms.2024.39.e84.
As the prevalence of hypertension increases with age and the proportion of the older population is also on the rise, research on the characteristics of older hypertensive patients and the importance of frailty is necessary. This study aimed to identify clinical characteristics of older hypertension in Korea and to investigate these characteristics based on frailty status.
The HOW to Optimize eLDerly systolic BP (HOWOLD-BP) is a prospective, multicenter, open-label, randomized clinical trial that aims to compare intensive (target systolic blood pressure [SBP] ≤ 130 mmHg) with standard (target SBP ≤ 140 mmHg) treatment to reduce cardiovascular events in older hypertensive Korean patients aged ≥ 65 years. Data were analyzed through a screening assessment of 2,085 patients recruited from 11 university hospitals. Demographic, functional (physical and cognitive), medical history, laboratory data, quality of life, and medication history of antihypertensive drugs were assessed.
The mean age was 73.2 years (standard deviation ± 5.60), and 48.0% (n = 1,001) were male. Prevalent conditions included dyslipidemia (66.5%), obesity (body mass index ≥ 25 kg/m², 53.6%), and diabetes (28.9%). Dizziness and orthostatic hypotension were self-reported by 1.6% (n = 33) and 1.2% (n = 24), respectively. The majority of patients were on two antihypertensive drugs (48.4%), while 27.5% (n = 574) and 20.8% (n = 433) were on 1 and 3 antihypertensive medications, respectively. Frail to pre-frail patients were older and also tended to have dependent instrumental activities of daily living, slower gait speed, weaker grip strength, lower quality of life, and lower cognitive function. The frail to pre-frail group reported more dizziness (2.6% vs. 1.2%, < 0.001) and had concerning clinical factors, including lower glomerular filtration rate, more comorbidities such as diabetes, stroke, and a history of admission. Frail to pre-frail older hypertensive patients used slightly more antihypertensive medications than robust older hypertensive patients (1.95 vs. 2.06, = 0.003). Pre-frail to frail patients often chose beta-blockers as a third medication over diuretics.
This study described the general clinical characteristics of older hypertensive patients in Korea. Frail hypertensive patients face challenges in achieving positive clinical outcomes because of multifactorial causes: they are older, have more morbidities, decreased function, lower quality of life and cognitive function, and take more antihypertensive medications. Therefore, it is essential to comprehensively evaluate and monitor disease-related or drug-related adverse events more frequently during regular check-ups, which is necessary for pre-frail to frail older patients with hypertension.
Clinical Research Information Service Identifier: KCT0003787.
随着高血压患病率随年龄增长而增加，老年人口的比例也在上升，因此有必要研究老年高血压患者的特征和衰弱的重要性。本研究旨在确定韩国老年高血压患者的临床特征，并根据衰弱状况调查这些特征。
优化老年收缩压（HOWOLD-BP）研究是一项前瞻性、多中心、开放标签、随机临床试验，旨在比较强化治疗（目标收缩压 [SBP] ≤ 130mmHg）与标准治疗（目标 SBP ≤ 140mmHg），以降低≥65 岁的韩国老年高血压患者的心血管事件风险。通过对来自 11 家大学医院的 2085 名患者进行筛选评估，对数据进行了分析。评估了人口统计学、功能（身体和认知）、病史、实验室数据、生活质量和降压药物的用药史。
患者平均年龄为 73.2 岁（标准差±5.60），48.0%（n=1001）为男性。常见的合并症包括血脂异常（66.5%）、肥胖（体重指数≥25kg/m²，53.6%）和糖尿病（28.9%）。头晕和体位性低血压分别有 1.6%（n=33）和 1.2%（n=24）的患者自述。大多数患者服用两种降压药（48.4%），而 27.5%（n=574）和 20.8%（n=433）的患者分别服用一种和三种降压药。虚弱到虚弱前期的患者年龄较大，且往往存在依赖的工具性日常生活活动、较慢的步行速度、较弱的握力、较低的生活质量和认知功能下降。虚弱到虚弱前期组报告头晕的比例更高（2.6%比 1.2%，<0.001），且存在令人担忧的临床因素，包括肾小球滤过率较低、合并症较多，如糖尿病、中风和住院史。虚弱到虚弱前期的老年高血压患者比强壮的老年高血压患者使用的降压药略多（1.95 比 2.06，=0.003）。虚弱到虚弱前期的患者常选择β受体阻滞剂作为第三种降压药，而不是利尿剂。
本研究描述了韩国老年高血压患者的一般临床特征。虚弱的高血压患者由于多种因素，在实现积极的临床结局方面面临挑战：他们年龄较大，合并症较多，功能下降，生活质量和认知功能较低，且服用更多的降压药物。因此，在常规检查中更频繁地全面评估和监测与疾病或药物相关的不良事件至关重要，这对高血压的虚弱到虚弱前期的老年患者尤为重要。
临床研究信息服务标识符：KCT0003787。
