管理老年人的高血压。

IF 3.9 2区 医学 Q1 PERIPHERAL VASCULAR DISEASE Current Hypertension Reports Pub Date : 2024-04-01 Epub Date: 2023-12-27 DOI:10.1007/s11906-023-01289-7
Brent M Egan, Holly J Mattix-Kramer, Jan N Basile, Susan E Sutherland
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引用次数: 0

摘要

审查目的:预计在 2015 年至 2050 年期间,全球 60-79 岁的老年人口将翻一番,从 8 亿人增至 16 亿人,而≥80 岁的成年人预计将增加两倍多,从 1.25 亿人增至 4.3 亿人。年龄每增加 10 岁,收缩压每增加 20 mmHg,发生心血管事件的风险就会增加一倍。因此,成功控制老年人的高血压对减轻心血管疾病预计带来的全球健康和经济负担至关重要:最近的研究结果:女性的寿命比男性长,但随着年龄的增长,收缩压和高血压的发病率比男性增加得更多,高血压的控制率比男性下降得更多,也就是说,老年人的高血压是一个不成比例的女性健康问题。在健康到轻度虚弱的老年人中,控制高血压(包括加强控制)对心血管事件的绝对益处,≥ 80 岁的成年人要大于 60-79 岁的成年人。与 60-79 岁的成年人相比,≥ 80 岁的成年人在降压治疗期间发生严重不良事件的绝对比率更高,但强化治疗与标准治疗相比,不良事件的超额发生率仅略有增加。在年龄≥80 岁的成年人中,如果存在中度至明显的虚弱,且认知功能低于大约第 25 百分位数,那么强化治疗的益处似乎并不存在。因此,评估老年人的功能和认知状况对于设定血压目标非常重要。鉴于加强降压治疗对独立生活的老年人的心血管绝对大有裨益,这一群体值得共同决定高血压目标。
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Managing Hypertension in Older Adults.

Purpose of review: The population of older adults 60-79 years globally is projected to double from 800 million to 1.6 billion between 2015 and 2050, while adults ≥ 80 years were forecast to more than triple from 125 to 430 million. The risk for cardiovascular events doubles with each decade of aging and each 20 mmHg increase of systolic blood pressure. Thus, successful management of hypertension in older adults is critical in mitigating the projected global health and economic burden of cardiovascular disease.

Recent findings: Women live longer than men, yet with aging systolic blood pressure and prevalent hypertension increase more, and hypertension control decreases more than in men, i.e., hypertension in older adults is disproportionately a women's health issue. Among older adults who are healthy to mildly frail, the absolute benefit of hypertension control, including more intensive control, on cardiovascular events is greater in adults ≥ 80 than 60-79 years old. The absolute rate of serious adverse events during antihypertensive therapy is greater in adults ≥ 80 years older than 60-79 years, yet the excess adverse event rate with intensive versus standard care is only moderately increased. Among adults ≥ 80 years, benefits of more intensive therapy appear non-existent to reversed with moderate to marked frailty and when cognitive function is less than roughly the twenty-fifth percentile. Accordingly, assessment of functional and cognitive status is important in setting blood pressure targets in older adults. Given substantial absolute cardiovascular benefits of more intensive antihypertensive therapy in independent-living older adults, this group merits shared-decision making for hypertension targets.

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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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