Burrell L M, Johnston C I
Department of Medicine, University of Melbourne, Austin and Repatriation Medical Centre, Melbourne, Victoria, Australia.
Drugs Aging. 1997 Jun;10(6):421-34. doi: 10.2165/00002512-199710060-00003.
Raised blood pressure in the elderly is not a normal consequences of aging, but is a major risk factor for cardiovascular disease. Cardiac and cerebrovascular disease account for > 50% of deaths among people aged > 65 years. Because the percentage of elderly people in most populations is rising, blood pressure control in this group is becoming increasingly important. Several large intervention studies in the elderly have demonstrated that antihypertensive medication reduces cardiovascular morbidity and mortality. In addition, the absolute benefits of blood pressure reduction are higher in elderly compared with younger patients. ACE inhibitors are effective and well tolerated in the treatment of hypertension in the elderly. Their success led to interest in alternative ways of blocking the renin angiotensin system, and the subsequent development of angiotensin II (AII) receptor antagonists. Losartan was the first drug in this class to become commercially available. Since then, valsartan has been launched in some markets and others are likely to be launched in the near future. Losartan is effective in the treatment of essential hypertension and has a low incidence of adverse effects. First-dose hypotension is very uncommon and, at the present time, cough does not appear to be an adverse effect of these drugs, although long term tolerability studies are needed to confirm this. Angioedema, a rare but life-threatening adverse effect of ACE inhibitors, has also been associated with losartan. Current data suggest that All receptor antagonists are effective in elderly hypertensive patients, although further data are needed to confirm these findings. At present, All receptor antagonists are likely to be used in hypertensive patients who are intolerant of ACE inhibitors, although this may change with the availability of long term tolerability and clinical outcomes data.
老年人血压升高并非衰老的正常结果，而是心血管疾病的主要危险因素。心血管疾病在65岁以上人群的死亡原因中占比超过50%。由于大多数人群中老年人的比例在上升，该群体的血压控制变得越来越重要。针对老年人的几项大型干预研究表明，抗高血压药物可降低心血管疾病的发病率和死亡率。此外，与年轻患者相比，老年人降低血压的绝对益处更高。ACE抑制剂在治疗老年高血压方面有效且耐受性良好。它们的成功引发了人们对阻断肾素血管紧张素系统其他方法的兴趣，随后开发出了血管紧张素II（AII）受体拮抗剂。氯沙坦是这类药物中首个上市的。此后，缬沙坦已在一些市场推出，其他药物也可能在不久的将来上市。氯沙坦在治疗原发性高血压方面有效，且不良反应发生率低。首剂低血压非常罕见，目前，这些药物似乎不会引发咳嗽不良反应，不过仍需长期耐受性研究来证实这一点。血管性水肿是ACE抑制剂罕见但危及生命的不良反应，也与氯沙坦有关。目前的数据表明，AII受体拮抗剂对老年高血压患者有效，不过还需要更多数据来证实这些发现。目前，AII受体拮抗剂可能用于不耐受ACE抑制剂的高血压患者，不过随着长期耐受性和临床结局数据的可得，这种情况可能会改变。
