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75岁以上和75岁以下的患者的血压控制

Hae Hyuk Jung¹

¹Department of Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, South Korea.

|February 1, 2024

概括

血压目标因年龄和危险因素而异. 虽然老年人和风险较低的人可能会从放松的系统血压 (SBP) 目标中受益,但具有多种风险因素的个人需要更严格的SBP控制.

科学领域:

心血管医学心血管医学
老年病的医生老年病的医生
腎臟病學 (nephrology) 是一種醫學專業.
神经学神经学

背景情况:

对抗高血压药物治疗的最佳系统血压 (SBP) 目标仍在争论中,特别是关于年龄和个体风险概况.
现有的指南缺乏基于年龄的SBP具体目标,导致临床实践的不确定性.
年龄,并发症和SBP水平对临床结果的相互作用需要进一步阐明.

研究的目的:

为了确定年龄特定的静缩血压 (SBP) 目标,用于抗高血压治疗.
调查治疗期间SBP水平与心脏-综合事件,痴呆症和不同年龄组和风险因素层中的全因死亡率之间的关联.

主要方法:

分析了296,470名75岁以上高血压患者的全国队列和259,028名45-74岁高血压患者的代表队列.
基于治疗期间每年平均的SBP水平,估计综合心血管-事件,明显痴呆症和全因死亡的发病率.
根据年龄的多变量调整和四个额外的危险因素的存在:糖尿病,失脂症,白色素尿和吸烟.

主要成果:

观察到SBP和心脏-脏事件之间的积极关联,在85岁以上的患者中风险减弱.
在老年人中,SBP与痴呆症风险呈现平坦或反转的关联,但在年轻人 (45-64岁) 中呈现小的积极关联.
在全因死亡率中发现了J形关联,随着年龄的增长,转向更高的SBP水平. 更严格的SBP控制 (145-154 mmHg vs. 125-134 mmHg) 与患有多种危险因素的患者的较高死亡率有关.

结论:

在非常老年患者 (≥85岁) 和具有较少并发症的老年人中,静脉血压目标可以放松.
相反,对于有多种危险因素的高血压患者,无论年龄大,都建议严格控制血压.
这些发现支持基于年龄和个人心血管风险概况的个性化抗高血压治疗策略.

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