Chalmers J
Department of Medicine, Flinders Medical Centre, Adelaide, South Australia.
Blood Press Suppl. 1995;3:6-10.
It has long been known that hypertension increases the risk of cardiovascular morbidity and mortality and that this risk increases with age. It has taken much longer to establish that lowering the blood pressure in elderly subjects will reduce this risk. Early studies published in 1985-86 indicated that treating classical essential hypertension in elderly subjects who were mainly less than 75 years of age, or even below 70 years, did reduce cardiovascular morbidity and mortality. More recent studies have extended the evidence and established that major benefits can be harvested by treating mild and moderate hypertension in subjects between 70 and 85 years who have classical hypertension with raised diastolic and systolic blood pressure. Recent evidence has also established that the treatment of isolated systolic hypertension in elderly patients up to the age of 80 and above, will reduce morbidity and mortality. In all of these recent studies, the major gain of lowering the pressure has been a reduction in the incidence of fatal and non-fatal stroke, but there is also some evidence of reduction in risk associated with coronary artery disease. Overall the evidence of benefit is sufficiently strong to advise the practising doctor to lower the blood pressure in elderly patients up to the age of 85 with raised diastolic or systolic blood pressure.
长期以来，人们都知道高血压会增加心血管疾病的发病率和死亡率，而且这种风险会随着年龄的增长而增加。而证实降低老年患者的血压能够降低这种风险则花费了更长的时间。1985 - 1986年发表的早期研究表明，治疗主要年龄小于75岁甚至低于70岁的老年患者的经典原发性高血压，确实能降低心血管疾病的发病率和死亡率。最近的研究进一步证实了这一点，并表明治疗70至85岁患有经典高血压且舒张压和收缩压升高的轻、中度高血压患者，可获得显著益处。最近的证据还表明，治疗80岁及以上老年患者的单纯收缩期高血压，将降低发病率和死亡率。在所有这些近期研究中，降低血压的主要益处是降低致命和非致命性中风的发生率，但也有一些证据表明与冠状动脉疾病相关的风险有所降低。总体而言，益处的证据足够有力，建议执业医生为舒张压或收缩压升高的85岁及以下老年患者降低血压。
