Reeves R A, Fodor J G, Gryfe C I, Patterson C, Spence J D
Department of Medicine, Sunnybrook Health Science Centre, University of Toronto, Ont.
CMAJ. 1993 Sep 15;149(6):815-20.
Several knowledge gaps, which made evidence-based guidelines impossible in 1985, have since been filled. There is now unequivocal evidence that treatment of isolated systolic hypertension benefits elderly patients, as does treatment beyond the age of 75 years. Pseudohypertension, although occasionally problematic, is not common and is not a reason to neglect the treatment of elderly patients, including those with isolated systolic hypertension. In general, long-term antihypertensive treatment of the elderly is well tolerated and does not cause important decreases in mental function. Comparative drug studies continue to accumulate; most show no clinically significant general differences between drugs, aside from the somewhat decreased efficacy and tolerability of beta-blockade in elderly patients. As in the young, certain drugs may be preferred in the presence of other conditions--e.g., congestive heart failure or diabetes.
1985年时导致无法制定循证指南的几个知识空白，此后已被填补。现在有明确的证据表明，单纯收缩期高血压的治疗对老年患者有益，75岁以上患者的治疗也是如此。假性高血压虽然偶尔会带来问题，但并不常见，也不是忽视老年患者治疗的理由，包括那些患有单纯收缩期高血压的患者。一般来说，老年人长期进行抗高血压治疗耐受性良好，不会导致心理功能显著下降。比较药物研究不断积累；大多数研究表明，除了老年患者中β受体阻滞剂的疗效和耐受性有所降低外，药物之间在临床上没有显著的总体差异。与年轻人一样，在存在其他疾病（如充血性心力衰竭或糖尿病）的情况下，某些药物可能更受青睐。
