老年人降压处方:实用指南》。

IF 3.9 2区 医学 Q1 PERIPHERAL VASCULAR DISEASE Current Hypertension Reports Pub Date : 2022-11-01 Epub Date: 2022-07-26 DOI:10.1007/s11906-022-01215-3
James P Sheppard, Athanase Benetos, Richard J McManus
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引用次数: 0

摘要

综述目的:总结有关适当和不适当停用降压药的证据:应按以下步骤尝试停药:(1)确定有多种并发症和功能明显下降的患者,即与多种药物治疗和血压下降相关的不良后果风险较高的人群;(2)检查血压;(3)确定可停药的候选药物;(4)每隔4周停药一次;(5)监测血压并检查不良反应。尽管有关降压药减量短期效果的证据不断积累,但长期效果仍不明确。降压药减量的证据有限,这意味着不应常规尝试降压药减量,除非是为了应对特定的不良事件,或在医生和患者就治疗的不确定性利弊进行讨论之后:需要进行临床对照试验,以研究降压治疗对老年患者的长期影响,尤其是对合并症和功能明显下降的患者。
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Antihypertensive Deprescribing in Older Adults: a Practical Guide.

Purpose of review: To summarise evidence on both appropriate and inappropriate antihypertensive drug withdrawal.

Recent findings: Deprescribing should be attempted in the following steps: (1) identify patients with several comorbidities and significant functional decline, i.e. people at higher risk for negative outcomes related to polypharmacy and lower blood pressure; (2) check blood pressure; (3) identify candidate drugs for deprescribing; (4) withdraw medications at 4-week intervals; (5) monitor blood pressure and check for adverse events. Although evidence is accumulating regarding short-term outcomes of antihypertensive deprescribing, long-term effects remain unclear. The limited evidence for antihypertensive deprescribing means that it should not be routinely attempted, unless in response to specific adverse events or following discussions between physicians and patients about the uncertain benefits and harms of the treatment.

Perspectives: Clinical controlled trials are needed to examine the long-term effects of deprescribing in older subjects, especially in those with comorbidities, and significant functional decline.

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来源期刊
Current Hypertension Reports
Current Hypertension Reports 医学-外周血管病
CiteScore
10.50
自引率
0.00%
发文量
65
审稿时长
6-12 weeks
期刊介绍: This journal intends to provide clear, insightful, balanced contributions by international experts that review the most important, recently published clinical findings related to the diagnosis, treatment, management, and prevention of hypertension. We accomplish this aim by appointing international authorities to serve as Section Editors in key subject areas, such as antihypertensive therapies, associated metabolic disorders, and therapeutic trials. Section Editors, in turn, select topics for which leading experts contribute comprehensive review articles that emphasize new developments and recently published papers of major importance, highlighted by annotated reference lists. An international Editorial Board reviews the annual table of contents, suggests articles of special interest to their country/region, and ensures that topics are current and include emerging research. Commentaries from well-known figures in the field are also provided.
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