老年高血压的诊断与治疗2009中国专家共识要点

1老年高血压的定义 根据1999年WHO高血压防治指南,年龄〉60岁、血压持续或3次以上非同日坐位血压收缩压（SBP）≥140mmHg和N（或）舒张压（DBP）≥90mmHg,可定义为老年高血压。若收缩压（SBP）≥140mmHg,舒张压（DBP）〈90mm Hg,则定义为老年单纯收缩期高血压（老年ISH）。     

汽车运输业高血压病的预防

高血压病是指舒张期和收缩期动脉血压的增高。诊断高血压应在一个月当中,在不同的日子里量三次血压,取其平均值,当其高于正常值时,才可诊断高血压。成人正常血压其收缩压应为≤140mmHg,舒张压应为≤90mmHg,以往成人高血压的诊断标准为收缩压≥160mmHg和舒张压≥90mmHg,但鉴于舒张压>90mmHg已可引起轻度靶器官(心,肾,脑)的损害,如眼底及基本实验室检查,尿分析,血钾,胸透或心电图,血胆固醇,甘油三酯等提示已有异常,故我认为成人血压>140/90mmHg已可以算是高血压了,凡是舒张压     

苯磺酸氨氯地平治疗老年高血压52例临床体会

老年高血压是指年龄〉60岁,持续或3次以上非同日坐位收缩压≥140 mmHg和（或）舒张压≥90 mmHg。若收缩压≥140 mmHg、张压〈90 mmHg则定义为老年单纯收缩期高血压[1]。     

中医对治疗老年性单纯收缩期高血压的研究进展

中华医学会老年学会根据世界卫生组织(WHO)西太平洋地区会议标准,提出老年人界限为＞60yr[1],另在《中国高血压治疗指南200修订版》中,收缩压≥140mmHg且舒张压＜90mmHg单列为单纯性收缩期高血压.因此将年龄＞60yr,且收缩压≥140mmHg、舒张压＜90mmHg定义为老年性收缩期高血压.收缩期高血压因之有较其他高血压更危险的心脑血管因素,有较高的致残、致死率,因此越来越成为人们广泛研究的热点[2].     

老年纯收缩期高血压特点及其治疗原则

高血压所致脑血管意外为最多,占42.75％。其中单纯收缩压增高为重要原因,目前已引起国内外学者关注。一、老年高血压的类型:按世界卫生组织标准(1978年),收缩压≥160mmHg,舒张压≥95mmHg为混合型高血压;舒张压≥95mmHg,收缩压≤160mmHg为单纯型舒张期高血压(亦称“经典”高血压);舒张压≤95mmHg而收缩压≥160mmHg称单纯性收缩期高血压。     

中国成年人高血压患病率、知晓率、治疗和控制状况

目的　评估中国成年人高血压的患病率、高血压知晓率、治疗和控制状况。方法　亚洲国际心血管病合作研究 (InterASIA)于 2 0 0 0～ 2 0 0 1年进行 ,应用多阶段抽样方法选择有代表性的样本。共调查了 35～ 74岁的成年人 15 838人。测量血压时 ,先让调查对象休息 5min ,由经过培训合格的调查人员应用标准水银柱血压计测量 3次血压。应用标准问卷询问高血压病史及高血压的治疗情况。高血压定义为收缩压≥ 140mmHg、舒张压≥ 90mmHg或正在服用降压药。结果　 35～ 74岁的中国成年人的高血压患病率为 2 7 2 %,即全国约有 1 3亿高血压患者。 35～ 44、45～ 5 4、5 5～ 6 4和 6 5～ 74岁年龄组的高血压患病专率分别为男性 17 4%、 2 8 2 %、 40 7%和 47 3 %;女性为 10 7%、2 6 8%、38 9%和 5 0 2 %。在高血压病人中 ,44 7%知道自己患有高血压 ,2 8 2 %正在服用降压药 ,8 1%的人血压得到了控制 ( <140 / 90mmHg)。在过去 10年中 ,高血压知晓、治疗和控制率的增长百分率分别为 86 2 %、92 6 %和 145 4%。结论　在过去的 10年中 ,高血压知晓、治疗和控制率有显著的提高。中国成年人高血压的患病率比较高 ,而高血压的知晓率偏低 ,治疗率和控制率又非常低。在我国迫切需要改善高血压的预防、检测和治疗状况     

中医对治疗老年性单纯收缩期高血压的研究进展

中华医学会老年学会根据世界卫生组织（wHo）西太平洋地区会议标准,提出老年人界限为〉60y[1],另在《中国高血压治疗指南2005修订版》中,收缩压≥140mmHg且舒张压〈90mmHg单列为单纯性收缩期高血压。因此将年龄〉60yr,且收缩压≥140mmHg、舒张压〈90mmHg定义为老年性收缩期高血压。,收缩期高血压因之有较其他高血压更危险的心脑血管因素,有较高的致残、致死率＇因此越来越成为人们广泛研究的热点[2]。     

高血压患者的用药策略

顾名思义,单纯性收缩期高血压也就是收缩压高于140mmHg,而舒张压却低于90mmHg,这种血压的表现占老年高血压病人总数的一半以上,年龄越大这种血压越多。老年高血压大部分是由于大动脉的粥样硬化导致动脉弹性明显减退,这与人体的生理老化和病理老化有着直接的关系。50岁以前的高血压病人很少有单纯性收缩期高血压的现象,60岁以后病人的收缩压会慢慢地升高,不易控制,收缩压与舒张压之间的脉压差越来越大,到70~80岁时,这种现象达到了顶峰,以后会有所下降。     

不同性别成人体质指数与不同亚型高血压关系

目的 探讨辽宁省彰武县成年人体质指数(BMI)与不同亚型高血压患病率的关系.方法 2001～2003年,采用整群抽样横断面调查方法,调查该地区18岁以上成年人6 710人,分析比较不同性别不同BMI各亚型高血压患病率、OR值差异.结果 随着BMI水平增加,男性和女性收缩压和舒张压均值逐渐增高.男、女性在低体重组、正常体重组、超重组和肥胖组的各亚型高血压患病率和OR值亦呈升高趋势.超重和肥胖(BMI≥24 kg/m2)时,与体重正常组相比,男性单纯性舒张期高血压(IDH)OR=2.16,收缩期和舒张期联合性高血压(SDH)OR=2.11,女性单纯性舒张期高血压(IDH)OR=1.62,收缩期和舒张期联合性高血压(SDH)OR=2.21,(P＜0.05).与非超重者相比,超重和肥胖男性中53.70%的IDH和52.60%的SDH归因于BMI≥24 kg/m2,女性有38.27%的IDH和54.75%的SDH由超重和肥胖引起.结论 体质指数与IDH和SDH亚型高血压的患病危险呈显著正相关;减重和控制肥胖对于预防IDH和SDH的发生有重要作用.     

社区65岁及以上老年人不同血压水平与其他代谢综合征指标的相关性

目的探讨社区65岁及以上老年人不同血压水平与其他代谢综合征指标的相关性,为社区老年人心脑血管事件的防治提供参考依据。方法选取2022年1-10月在福建省泉州市丰泽区北峰、清源2个街道社区卫生服务中心进行健康体检的65岁及以上老年人,剔除关键变量缺失及异常值46名,最终实际纳入3598名老年人作为研究对象。根据血压水平分为正常血压组[收缩压<120 mmHg(1 mmHg=0.133 kPa)和舒张压<80 mmHg]、正常高值血压组[收缩压120~139 mmHg和(或)舒张压80~89 mmHg]和高血压组[收缩压≥140 mmHg和(或)舒张压≥90 mmHg]。其中高血压组又分4个亚组:1级高血压组[收缩压140~159 mmHg和(或)舒张压90~99 mmHg]、2级高血压组[收缩压160~179 mmHg和(或)舒张压100~109 mmHg]、3级高血压组[收缩压≥180 mmHg和(或)舒张压≥100 mmHg]、单纯收缩期高血压组(收缩压≥140 mmHg和舒张压<90 mmHg)。比较不同水平血压组的一般资料和体质量指数(body mass index,BMI)、空腹血糖、总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、血肌酐、血尿素氮及脂肪肝等代谢指标的差异。结果高血压患病率为50.64%(1822/3598),代谢综合征患病率为21.40%(770/3598),超重肥胖、血脂紊乱、高血压、高血糖检出率较高。随着血压水平的升高,各组BMI、腰围、腰高比、空腹血糖、总胆固醇、甘油三酯、低密度脂蛋白胆固醇、血肌酐水平呈递增趋势,差异有统计学意义(P<0.05)。进一步对不同血压水平分组的上述代谢指标两两比较分析,正常高值血压组高于正常血压组,各级(1、2、3级)高血压组高于正常高值血压组,单纯收缩期高血压组与各级(1、2、3级)高血压组比较,差异有统计学意义(P<0.05)。线性趋势检验结果显示,年龄、BMI与血压水平之间存在线性关系,差异有统计学意义(χ^(2)值分别为43.22,21.92,P<0.01)。结论社区65岁及以上老年人群中具有较高的高血压及代谢综合征患病率,且不同血压水平与多代谢异常存在密切联系,需早期采取综合性干预措施。     

Women, employment status, and hypertension: cross-sectional and prospective findings from the Atherosclerosis Risk in Communities (ARIC) Study.

PURPOSE: This study examined the cross-sectional and prospective associations between employment status and hypertension among middle-aged, African-American (AA) and European-American (EA) women participating in the Atherosclerosis Risk in Communities Study. METHODS: Employed women and homemakers from the baseline examination (1987-89) were included in the cross-sectional study (n = 7351). Associations between employment and the incidence of hypertension ascertained at visit 2 (1990-92) were determined among those who at baseline, had low-normal blood pressure (not hypertensive and systolic blood pressure (SBP) < or = 120 mm Hg systolic and diastolic blood pressure (DBP) < or =80 mm Hg (n = 3194). Logistic regression analysis was used to examine the association between employment status and hypertension by ethnicity, taking into account covariates. RESULTS: At baseline, employed women were less likely to be hypertensive (SBP > or =140 mm Hg or DBP > or =90 mm Hg or current use of antihypertensive drugs) than were homemakers (prevalence odds ratio) (POR) = 0.70; 95% confidence interval (CI) = 0.62-0.79), controlling for age, body mass index, and education. Among the subgroup who had low-normal blood pressure at baseline, employed women were less likely to develop hypertension during the three-year time period than were homemakers (odds ratio (OR) = 0.68; 95% CI = 0.44-1.05). The inverse association was stronger among AA (RR = 0.37; 95% CI = 0.16-0.88) than EA (OR = 0.83; 95% CI = 0.50-1.38) women. CONCLUSIONS: These findings suggest that the inverse association between hypertension and employment status is not due to a healthy worker effect, and that employment may confer protection against incident hypertension in women.     

Pet ownership and blood pressure in old age

BACKGROUND: It has been proposed that pet ownership improves cardiovascular health. This study examines the relation of pet ownership with systolic and diastolic blood pressure, pulse pressure, mean arterial pressure, and hypertension in a large sample of older men and women. METHODS: Participants were 1179 community-dwelling men (n = 498) and women (n = 681) age 50-95 years. Participants responded to a 1991-1992 mailed questionnaire ascertaining pet ownership, and they attended a 1992-1996 clinic visit at which systolic (SBP) and diastolic (DBP) blood pressures were measured and use of antihypertensive medication was validated. Pulse pressure was calculated as SBP minus DBP. Mean arterial pressure was calculated as (SBP+DBP)/2. Body mass index, waist-hip ratio, and information on other potential confounders were obtained. RESULTS: Average age of participants was 70.4 +/- 10.8 years; 30.0% reported current pet ownership. Mean SBP was 137.5 +/- 21.4 mm Hg, and DBP was 76.1 +/- 9.3 mm Hg; 55.6% were hypertensive (SBP >or= 140, DBP >or= 90 or taking hypertension medication). Pet owners were younger and slightly more overweight and they exercised less than nonowners; owners were somewhat more likely to have diabetes and to use beta-blockers. In unadjusted analyses, pet owners had lower SBP, pulse pressure, and mean arterial pressure, and a reduced risk of hypertension (odds ratio = 0.62; 95% confidence interval = 0.49-0.80). However, after adjustment for age and other confounders, pet ownership was not associated with systolic or diastolic blood pressure, pulse pressure, mean arterial pressure or risk of hypertension. CONCLUSIONS: Results suggest that pet ownership is not independently associated with blood pressure, vascular reactivity, or hypertension.     

Hypertension in the nursing home

Hypertension in a nursing home patient is a systolic blood pressure of 140 mm Hg or higher and 130 mm Hg or higher in a patient with diabetes mellitus or chronic renal insufficiency, or a diastolic blood pressure of 90 mm Hg or higher and 80 mm Hg or higher in a patient with diabetes mellitus or chronic renal insufficiency. Numerous prospective, double-blind, randomized, placebo-controlled studies have demonstrated that antihypertensive drug therapy reduces the development of new coronary events, stroke, and congestive heart failure in older persons. The goal of treatment of hypertension in elderly persons is to lower the blood pressure to less than 140/90 mm Hg and to less than 130/80 mm Hg in older persons with diabetes mellitus or chronic renal insufficiency. Elderly persons with diastolic hypertension should have their diastolic blood pressure reduced to 80 to 85 mm Hg. Diuretics should be used as initial drugs in the treatment of older persons with hypertension and no associated medical conditions. The selection of antihypertensive drug therapy in persons with associated medical conditions depends on their associated medical conditions. If the blood pressure is more than 20/10 mm Hg above the goal blood pressure, drug therapy should be initiated with 2 antihypertensive drugs, one of which should be a thiazide-type diuretic. Other coronary risk factors must be treated in patients with hypertension.     

Analysis of risk factors for hypertension in Colima, Mexico]

OBJECTIVE: To evaluate the possible association that age, sex, excess weight, family history of hypertension, alcoholism, and sedentary lifestyle have with hypertension in the adult population of the city of Colima, Mexico. METHODS: This was a population-based analytic cross-sectional study. A structured survey was used with 280 adults older than 30 years of age who were living in the city of Colima in 2001 and 2002. The variables studied were sex, age, weight, height, family history of hypertension, engaging in physical exercise, smoking, and consuming alcohol. Blood pressure (BP) was measured with the auscultatory method. Borderline or doubtful measurements were checked again four or five days later. Hypertension was defined as systolic BP > or = 140 mm Hg and diastolic blood pressure > or = 90 mm Hg, or as the person being under antihypertensive treatment. The odds ratios (ORs) of the variables studied were calculated, along with their 95% confidence intervals (95% CIs). The association between the variables and hypertension was estimated through logistic regression, and their interaction through the coefficient of the interaction products. RESULTS: The overall prevalence of hypertension was 28.6%. The prevalence was higher in men than in women (42.1% vs. 19.2%; OR = 3.04, 95% CI: 1.8 to 5.2) and in people older than 49 years than in people 30 to 49 years old (36.8% vs. 21.9%; OR = 2.07, 95% CI: 1.22 to 3.50). A family history of hypertension and excess weight were associated with hypertension, while physical exercise had a protective effect (OR = 0.45; 95% CI: 0.23 to 0.86). There was interaction between hypertension and age > or = 50 years, a family history of hypertension, overweight, and physical exercise, especially among women. CONCLUSIONS: The prevalence of hypertension in Colima is very similar to that for Mexico as a whole. The strong association that hypertension had with male gender, regardless of the other variables, emphasizes the need for promoting prevention campaigns that focus more on men.     

Coffee intake and incidence of hypertension

BACKGROUND: The long-term longitudinal evidence for a relation between coffee intake and hypertension is relatively scarce. OBJECTIVE: The objective was to assess whether coffee intake is associated with the incidence of hypertension. DESIGN: This study was conducted on a cohort of 2985 men and 3383 women who had a baseline visit and follow-up visits after 6 and 11 y. Baseline coffee intake was ascertained with questionnaires and categorized into 0, >0-3, >3-6, and >6 cups/d. Hypertension was defined as a mean systolic blood pressure (SBP) >or=140 mm Hg over both follow-up measurements, a mean diastolic blood pressure (DBP) >or=90 mm Hg over both follow-up measurements, or the use of antihypertensive medication at any follow-up measurement. RESULTS: Coffee abstainers at baseline had a lower risk of hypertension than did those with a coffee intake of >0-3 cups/d [odds ratio (OR): 0.54; 95% CI: 0.31, 0.92]. Women who drank >6 cups/d had a lower risk than did women who drank >0-3 cups/d (OR: 0.67; 95% CI: 0.46, 0.98). Subjects aged >or=39 y at baseline had 0.35 mm Hg (95% CI: -0.59, -0.11 mm Hg) lower SBP per cup intake/d and 0.11 mm Hg lower DBP (95% CI: -0.26, 0.03 mm Hg) than did those aged <39 y at baseline, although the difference in DBP was not statistically significant. CONCLUSIONS: Coffee abstinence is associated with a lower hypertension risk than is low coffee consumption. An inverse U-shaped relation between coffee intake and risk of hypertension was observed in the women.     

Can a decline in the population means of cardiovascular risk factors reduce the number of people at risk?

OBJECTIVE: To prove the possibility of shifting distribution of cardiovascular risk factors for a whole population over time and thereby to influence the prevalence of the corresponding disease states, according to the theory stated by Geoffrey Rose in 1985. DESIGN: Examination of standardised data from the German Cardiovascular Prevention Study (GCP), a seven year long, population-based, multicentre intervention trial, concerned with decreasing risk factors for cardiovascular disease. SETTING AND SUBJECTS: three cross sectional surveys of a population 25 to 69 years old in six study regions, and three nationwide cross sectional surveys in the former West Germany in 1984, 1988 and 1991. MAIN OUTCOME MEASURES: The relation between the population mean for systolic and diastolic blood pressure, total serum cholesterol, body mass index, and alcohol intake, and the prevalence of the corresponding disease states, as are systolic (> or =140 and > or =160 mm Hg) and diastolic hypertension (> or =90 and > or =95 mm Hg), hypercholesterolaemia (> or =250 and > or =300 mg/dl), overweight (body mass index > or =30 kg/m2), and heavy drinking (weekly alcohol intake > or =300 g/week). Results are expressed as linear regression equations and Pearson correlation coefficients. RESULTS: The correlation between the mean population values and prevalence of disease was close for blood pressures and body mass index. The Pearson coefficients, corrected for the influence of values increased above borderlines, were 0.86 and 0.81 respectively for systolic blood pressure, 0.88 and 0.91 for diastolic blood pressure, 0.28 and 0.52 for cholesterol, and 0.86 for the body mass index. The coefficient for alcohol intake was 0.55. CONCLUSIONS: It seems possible to shift the risk distribution of a population for some physiological parameters over time with the effect of changing the disease prevalence. This strategy can be used successfully for specific preventive measures, as was strongly advocated by Geoffrey Rose.     

中国中年人群高血压患病率及知晓率、治疗率、控制率的演变趋势

目的 了解中年人群高血压患病率及知晓率、治疗率和控制率的演变趋势。方法 利用国家“八五”(1992～1994年)和“九五”(1998年)期间年龄在35～59岁的13组可比人群资料进行分析。结果 高血压的标化患病率有小幅增加,“九五”期间达到24.0％。城市的增幅要大于乡村。高血压知晓率“九五”期间较“八五”期间增加了5.3％,达到42.6％;治疗率“八五”期间27.3％、“九五”期间为31.1％;控制率“九五”期间较“八五”期间增加了近50％,但也只有6.0％。在接受治疗的高血压患者中,不同时期的控制率分别为12.7％、19.9％,为同期整体控制率的3倍多。无论患病率、知晓率、治疗率和控制率,城乡之间、性别之间都存在差异。结论 不断上升的高血压患病率和低水平的知晓率、治疗率、控制率仍是高血压防治面临的主要现状。必须认真开展有效的措施以降低高血压的患病率,提高治疗率和控制率。     

The relationship between shift work and the onset of hypertension in male Japanese workers

We assessed the effect of shift work on the onset of hypertension. The design of this study was that of a cohort study from 1991-2001. In sum, 5338 workers comprised this cohort. The event was the onset of hypertension (systolic blood pressure >or=140 mm Hg and/or diastolic blood pressure >or=90 mm Hg and/or medication). Pooled logistic regression analysis was performed, including job schedule type, age, body mass index, lifestyle, and the results of blood chemistries as covariates. The odds ratio of the onset of hypertension in shift workers for daytime workers was 1.10 and significant. Our study revealed that shift work independently affected the onset of hypertension, and suggested that shift work is a risk factor for the onset of hypertension.     

Hypertension and road traffic noise exposure

OBJECTIVE: The purpose of this study was to assess the relationship between road traffic noise exposure at home and the prevalence of hypertension. METHODS: We conducted cross-sectional analyses in a large random sample (N=40,856) of inhabitants of Groningen City, and in a subsample (the Prevention of Renal and Vascular End-Stage Disease [PREVEND]) study cohort; N=8592). RESULTS: Before adjustment for confounders, road traffic noise exposure was associated with self-reported use of antihypertensive medication in the city of Groningen sample (odds ratio [OR]=1.31 per 10-dB increase in Lden). Adjusted odds ratios were significant for the subjects between 45 and 55 years old in the full model when adjusted for PM10 (OR=1.19) and at higher exposure (Lden >55 dB) only (OR=1.21; with adjustment for PM10, OR=1.31). In the PREVEND cohort, the unadjusted odds ratio was 1.35 for hypertension (systolic and diastolic blood pressure >140 and >90 mm Hg, respectively, or use of antihypertensive medication). Again, the adjusted odds ratio was significant for subjects between 45 and 55 years old (OR=1.27; with adjustment for PM10, OR=1.39). CONCLUSIONS: Exposure to road traffic noise may be associated with hypertension in subjects who are between 45 and 55 years old. Associations seemed to be stronger at higher noise levels.