Kuramoto K, Matsushita S, Kuwajima I
Jpn Circ J. 1981 Jul;45(7):833-43. doi: 10.1253/jcj.45.833.
The clinicopathological study on the atherosclerosis and cerebrovascular and cardiac complications was carried out in 1561 consecutive autopsied cases in the elderly. The subjects were classified into 3 groups: 702 cases (45.0%) of normotension, 276 cases (17.7%) of systolic hypertension and 583 cases (37.3%) of diastolic hypertension. The acceleration of atherosclerosis by hypertension was prominent in sixties and seventies, less remarkable in eighties and almost none in nineties. The effect of hypertension was remarkable on cerebral artery, aorta and coronary artery in this order, and no difference was found between the systolic and diastolic hypertension groups. On the basis of atherosclerotic changes, strokes and myocardial infarction were prevalent in both these groups in comparison with the normotension group. The difference between the systolic and diastolic hypertension groups and the normotension group was prominent in sixties and seventies, but in eighties only the diastolic hypertension group showed a significant difference with the normotension group. The effect of hypertension was more remarkable on strokes than myocardial infarction. The lack of remarkable effect of hypertension on the cases over eighty may be attributed to the progression of atherosclerosis with age in normotensive cases. The 4 year prospective trial on the effectiveness of the antihypertensive treatment was performed in 100 mild hypertensive patients of the aged, averaging 76.1 years. The matched pair group was selected by the age, sex and blood pressure. Cerebrovascular and cardiac complications were observed in 4 cases of 10.5% of 38 cases of the drug group, and in 9 cases or 22.0% of 41 cases of the placebo group. When the elevation of blood pressure over 200/110 mmHg, observed in 8 cases in the placebo group, were included as one of the cardiovascular complications, the complications in placebo group reached 41.5%, showing a significant difference. Other complications such as cancers, infections and bone or joint diseases, were observed in 12 cases or 31.6% in the drug group and in 17 cases or 41.5% in the placebo group. Blood pressure was decreased from 171/87 to 151/80 in the drug group in the 4 year period. The present study suggested that antihypertensive treatment was effective in the aged hypertension, and careful follow up was needed not only for cardiovascular complications but also for general health condition.
对1561例老年连续尸检病例进行了动脉粥样硬化及脑血管和心脏并发症的临床病理研究。研究对象分为3组：702例（45.0%）血压正常者，276例（17.7%）收缩期高血压患者，583例（37.3%）舒张期高血压患者。高血压对动脉粥样硬化的加速作用在六七十岁时最为显著，八十岁时不太明显，九十岁时几乎没有。高血压对脑动脉、主动脉和冠状动脉的影响依次最为显著，收缩期高血压组和舒张期高血压组之间未发现差异。基于动脉粥样硬化改变，与血压正常组相比，这两组中风和心肌梗死均很常见。收缩期高血压组和舒张期高血压组与血压正常组之间的差异在六七十岁时最为显著，但在八十岁时只有舒张期高血压组与血压正常组存在显著差异。高血压对中风的影响比对心肌梗死更为显著。高血压对八十岁以上病例缺乏显著影响可能归因于血压正常病例中动脉粥样硬化随年龄的进展。对100例平均年龄76.1岁的老年轻度高血压患者进行了为期4年的抗高血压治疗效果前瞻性试验。通过年龄、性别和血压选择匹配对照组。药物组38例中有4例（10.5%）出现脑血管和心脏并发症，安慰剂组41例中有9例（22.0%）出现。当将安慰剂组中8例血压升高超过200/110 mmHg作为心血管并发症之一纳入时，安慰剂组的并发症发生率达到41.5%，显示出显著差异。药物组有12例（31.6%）出现其他并发症，如癌症、感染和骨骼或关节疾病，安慰剂组有17例（41.5%）出现。4年期间药物组血压从171/87降至151/80。本研究表明抗高血压治疗对老年高血压有效，不仅需要密切关注心血管并发症，还需要关注总体健康状况。
