高血压的目标,药物考虑和老年人高血压的特殊问题第一部分:一般原则和特殊考虑
Heng-Yu Pan1, Po-Lung Yang2, Chun-Hsien Lin3
1Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu City, Taiwan.
Journal of the Formosan Medical Association = Taiwan yi zhi
|September 25, 2024
概括
在老年人中,控制血压需要平衡心脏的益处与风险. 对于65-80岁的人来说,缩压低于130mmHg,老年人或慢性病患者的个性化目标.
科学领域:
- 老年学是一门学科.
- 心脏病学 心脏病学
- 腎臟病學 (nephrology) 是一種醫學專業.
背景情况:
- 对老年人来说,最佳血压 (BP) 目标是一个挑战,需要平衡心血管优势与器官输血低的风险.
- 有证据表明,年龄和脆弱程度对社区老年人密集血压控制对心血管的影响最小.
- 然而,密集的血压控制与八岁以上人群急性损伤的增加有关.
研究的目的:
- 建立对老年人最佳血压目标的共识.
- 评估年龄和脆弱对密集血压控制的好处和风险的影响.
- 为老年高血压患者提供关于抗高血压药物选择和治疗策略的指导.
主要方法:
- 对老年人血压目标的现有证据的审查.
- 对密集血压控制的心血管益处与风险的分析.
- 考虑慢性病 (CKD) 和患者年龄组等特定疾病.
主要成果:
- 对于65-80岁的高血压患者,建议系统血压目标低于130 mmHg.
- 静脉血压目标低于120mmHg可能适合CKD患者,如果耐受.
- 对于80岁及以上的个人,没有确定的BP目标.
结论:
- 老年人高血压管理需要个性化策略,权衡心血管益处与个人风险和耐受性.
- 药物选择,包括ACE抑制剂,ARB和矿物质皮质类受体对抗剂,应考虑患者的慢性瘤等并发症.
- 在这种人群中,可能需要组合治疗来达到目标血压水平.
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