Sarnaik Kunaal S, Mirzai Saeid
Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA.
Department of Cardiovascular Medicine, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27101, USA.
J Vasc Dis. 2025 Jun;4(2). doi: 10.3390/jvd4020018. Epub 2025 May 14.
The aging of the global population over recent decades has resulted in an increased prevalence of hypertension in older adults. Hypertension develops with increasing age primarily due to a disastrous feedback loop of increased arterial stiffness and maladaptive hemodynamics; this is compounded by age-related changes in physiology. The risk of adverse hypertension-related outcomes concurrently increases with age, and optimal blood pressure (BP) control in older adults thus becomes increasingly important each year. The results of several randomized clinical trials (RCTs) evaluating antihypertension strategies in older adults have concluded that the potential benefits of intensive BP management outweigh the risks of harm. However, the exclusion of frail, multimorbid, and institutionalized individuals limits the generalizability of such findings to the broader population of older patients with hypertension. Secondary analyses and external studies have continued to support intensive BP control strategies in older adults with frailty or sarcopenia. Therefore, based on available evidence, clinicians should continue practicing intensive BP control strategies in the older population, yet careful consideration of functional status, life expectancy, medication side effects, polypharmacy, and multimorbidity must take place to avoid unnecessary harm. Strategies must then be tailored to accommodate modifiers such as frailty and sarcopenia in older adults with hypertension. Knowledge gaps underscore the need for future studies evaluating BP management in older adults that incorporate greater proportions of multimorbid and institutionalized individuals with frailty, assess personalization of treatment, and identify subgroups in which optimal BP levels exist or the permissibility of higher BP levels is safer than BP reduction.
近几十年来，全球人口老龄化导致老年人群中高血压患病率上升。高血压随着年龄增长而出现，主要是由于动脉僵硬度增加和血流动力学适应不良的灾难性反馈循环所致；与年龄相关的生理变化使情况更加复杂。与高血压相关的不良后果风险也随年龄增加，因此，每年对老年人进行最佳血压（BP）控制变得越来越重要。几项评估老年人群抗高血压策略的随机临床试验（RCT）结果得出结论，强化血压管理的潜在益处超过了伤害风险。然而，排除体弱、多病和机构化个体限制了这些研究结果对更广泛的老年高血压患者群体的普遍性。二次分析和外部研究继续支持对体弱或肌肉减少症的老年人采取强化血压控制策略。因此，根据现有证据，临床医生应继续在老年人群中实施强化血压控制策略，但必须仔细考虑功能状态、预期寿命、药物副作用、多重用药和多病共存情况，以避免不必要的伤害。然后必须制定策略，以适应老年高血压患者中诸如体弱和肌肉减少症等影响因素。知识空白凸显了未来研究的必要性，这些研究应评估老年人群的血压管理，纳入更大比例的体弱、多病和机构化个体，评估治疗的个性化，并确定存在最佳血压水平或较高血压水平比降低血压更安全的亚组。
