老年患者のポリファーマシー:オクトジェナリアンの高血圧管理

Athanase Benetos¹, Patrick Rossignol², Antonio Cherubini³

¹Department of Geriatrics and FHU-CARTAGE, CHU de Nancy, Université de Lorraine, Nancy, France.

JAMA

|July 15, 2015

まとめ

高血圧の治療は,健康で独立した80歳児に利益をもたらします. しかし,複数の薬剤を服用している弱体で高齢の患者については,個々のケアを必要とする証拠は不十分です.

科学分野:

ゲロントロジーはゲロントロジーの学科です.
心血管医学心血管医学
臨床薬理学臨床薬理学とは

背景:

高血圧管理は,ほとんどの患者にとって非常に重要です.
複数の薬を服用している非常に高齢で弱い個体における高血圧の治療の利点は,それほど明確ではありません.

研究の目的:

80歳以上の患者における高血圧の評価と治療に関する勧告を策定する.

主な方法:

検索はMEDLINE,PubMed Central,およびコクラン体系的レビューデータベース (2015年4月開始) で行われました.
80代における抗高血圧薬の使用に関するランダム化対照試験 (RCT) を含め,非常に高齢者試験 (HYVET) の高血圧のポストホック分析に焦点を当てました.

主要な成果:

HYVET試験 (N=3845) は,全死亡率と心血管疾患のエンドポイントの減少を示したが,脳卒中予防の統計的有意性には達しなかった.
ポストホック分析では,ホワイトコート高血圧,認知,および潜在的な骨折の予防に有益であることが示されました.
HYVETの患者はコミュニティに住んでおり,一般の80代の人口よりも障害が少ない.

結論:

80歳以上の健康で機能的に独立した高血圧患者は,65歳以上の患者に対するガイドラインに従うべきです.
脆弱で多剤薬剤を服用している8歳児の治療には十分な証拠が欠け,個別化されたアプローチが必要である.

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