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摘要: 伴随我国人口老龄化进程加速，老年高血压患者的数量逐年增加。目前通常情况下，年龄≥65岁的高血压患者被定义为老年高血压。与中青年高血压患者相比，老年高血压患者的发病机制、临床表现具有特殊性，患者心脑血管事件显著增加。老年高血压多表现为单纯收缩期高血压、脉压增大、血压易波动、合并疾病多等特点，与年轻患者相比降压治疗的难度增加。老年高血压的治疗目的是保护靶器官、减少心脑血管事件，但老年人的降压获益与患者治疗耐受性以及降压治疗的潜在危害相关，在治疗时应选择个体化治疗方案并全面评估和密切监测患者情况，平稳降压，其降压目标可设为＜150/90 mm Hg(1 mm Hg=0.133 kPa)。Abstract: With the acceleration of population aging in China, the number of older people with hypertension is increasing year by year. In general, elderly is defined as ≥65 years old. Compared to middle-aged and young patients, the elderly with hypertension have their own particularity and the cardiovascular events significantly increase. Older patients are more likely to have isolated systolic hypertension, raised pulse pressure, an obvious variation of blood pressure(BP), and associated complications. Therefore, BP control in the elderly presents more difficulties than in younger people. Antihypertensive treatment for older patients should aim to protect target organs and reduce the incidence of cardio-cerebrovascular events. The benefits of BP treatment in older patients will be influenced by the patients' tolerance to treatment and potentially harmful effects of BP-lowering treatment. In order to attain a safe and steady BP-lowering, it is especially important to take individualized treatment strategies based on complete clinical evaluation and careful monitoring of patients. The target BP < 150/90 mm Hg (1 mm Hg=0.133 kPa) is recommended in older hypertensive patients.
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Key words:
- hypertension /
- blood pressure-lowing treatment /
- elderly
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表 1 国内外不同高血压防治指南中的降压目标
指南 降压目标 JNC 8[17] ≥60岁，＜150/90 mm Hg 2017 ACC/AHA高血压指南[15] ≥65岁，有活动能力的老年人，收缩压＜130 mm Hg 老年高血压的诊断与治疗中国专家共识(2017年版)[10] ≥65岁，＜150/90 mm Hg，若能耐受可降至140/90 mm Hg以下 2018 ESC/ESH高血压指南[16] ≥65岁，若能耐受，收缩压130~139mm Hg，舒张压70~79mm Hg 中国高血压防治指南2018年修订版[5] 65~79岁，首先降至＜150/90 mm Hg，若能耐受可降至＜140/90 mm Hg; ≥80岁，降至＜150/90 mm Hg JNC：美国预防、检测、评估与治疗高血压全国联合委员会；ACC/AHA：美国心脏病学会/美国心脏协会；ESC/ESH：欧洲心脏病学会/欧洲高血压学会 
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