Wiersinga Julia, Jansen Sofie, Peters Mike J L, Rhodius-Meester Hanneke F M, Trappenburg Marijke C, Claassen Jurgen A H R, Muller Majon
Department of Internal Medicine, Section Geriatrics, Amsterdam UMC, Boelelaan 1117, Amsterdam, the Netherlands.
Amsterdam Cardiovascular Sciences, Atherosclerosis & Ischemic Syndromes, Amsterdam, the Netherlands.
Lancet Reg Health Eur. 2024 Dec 3;48:101154. doi: 10.1016/j.lanepe.2024.101154. eCollection 2025 Jan.
Hypertension and orthostatic hypotension (OH) frequently coexist in the older population, both stemming from impaired blood pressure (BP) regulation. Managing hypertension in patients with OH presents a significant clinical challenge, particularly in frail older adults who are also prone to falls. Hypertension treatment is often suboptimal in this population due to concerns over the potential increased risk of falls associated with treatment. However, current clinical guidelines provide limited guidance on managing this complex issue. This review explores the pathophysiology of hypertension and OH, reviews existing guidelines, and examines the evidence surrounding hypertension management in patients with OH. Additionally, we provide an overview of research focused on frail older adults and offer expert-opinion-based recommendations for the management of hypertension and OH in routine clinical practice.
高血压和体位性低血压（OH）在老年人群中经常并存，二者均源于血压（BP）调节受损。在患有OH的患者中管理高血压是一项重大的临床挑战，尤其是在也容易跌倒的体弱老年人中。由于担心治疗相关的跌倒风险可能增加，该人群的高血压治疗往往未达最佳状态。然而，目前的临床指南在处理这一复杂问题方面提供的指导有限。本综述探讨了高血压和OH的病理生理学，回顾了现有指南，并审视了OH患者高血压管理的相关证据。此外，我们概述了针对体弱老年人的研究，并针对常规临床实践中高血压和OH的管理提供基于专家意见的建议。
