高龄老年高血压的临床及治疗特点分析

目的探讨高龄老年高血压的临床治疗特点及治疗方法。方法随访52例高龄老年高血压病例0．5～3年,总结临床资料并进行分析。结果老年高血压病患者的特点是发病率高,病程长,预后较差,但通过针对性的预防及治疗措施,血压控制较为满意。结论根据老年高血压的临床特点,联合用药可有效控制血压。     

高龄高血压患者降压治疗的相关问题

随着人口老龄化,高龄老人高血压在医疗保健系统中是一个主要的日益增长的负担,需社会的关注.现回顾近年有关高龄高血压患者的管理指南以及治疗预后研究,高龄高血压患者的降压目标、治疗的获益和风险、衰弱和血压之间的关系等相关问题仍有待明确,需探索管理高龄高血压患者更适合的策略.     

高血压患者血压控制未达标原因的调查分析

目的对高血压患者血压控制未达标的原因进行调查分析。方法回顾我院2007年5月—2011年6月年住院治疗及门诊治疗高血压病患者200例血压控制未达标的原因,并针对各种血压未达标原因制定个性化的降压方案,减少影响降压的不利因素,积极合理降压。结果 200例患者有190例经合理指导降压后血压均控制在正常范围,总有效率为95.0%。结论高血压患者血压控制未达标与患者不健康的生活方式、不合理的联合用药和患者用药依从性差有关。     

高龄老人高血压的治疗现状及体位改变的相关因素

目的探讨高龄老人高血压的治疗现状及体位改变的相关因素。方法选择2015年1~7月高龄老人2 000例进行问卷调查,观察患者降压药物使用情况、随访血压情况、影响降压治疗的因素以及体位性低血压(OH)和体位性高血压(OHT)与心血管疾病的关系。结果高龄老人高血压患者使用的降压药物包括:钙拮抗剂(54.73%)、血管紧张素转换酶抑制(16.25%)、血管紧张素受体抑制剂(17.04%)、利尿剂(6.82%)、β受体阻滞剂(3.54%)和其他药物(1.62%)。患者血压测量主要在医院/医疗机构测量(51.07%)和家庭自测(36.14%)。大多数患者坚持每天、每月血压测量(96.82%),部分患者每年一次或者从不进行血压监测(3.18%)。908例高龄高血压患者中,诊断为OH者298例(32.82%),OHT者171例(18.83%)。OH组、OHT组患者冠心病、高脂血症、糖尿病和脑卒中的患病率均高于非OH/OHT组(P0.05)。结论高龄老人高血压的治疗药物中,钙拮抗剂、肾素血管紧张素系统阻断剂得到广泛认同,而利尿剂的使用相对不足,患者自我管理模式的实行有待加强,冠心病、高脂血症、糖尿病、脑卒中均与体位改变有关。     

动态血压监测老年高血压患者降压治疗效果

偶测血压 (即诊所血压 )是诊断高血压的依据 ,也是临床医生调整指导用药的重要指标 ,但高血压患者虽然经过积极的降压治疗 ,心血管病发生率仅下降 1 9% [1 ] ,有学者指出其可能原因之一是降压不足 ,偶测血压 (诊所血压 )并不能完全反映患者 2 4h的血压控制情况 ,应用 2 4h动态血压监测能更好地反映患者的血压控制情况[2 ] 。本文对 1 0 0例治疗后老年高血压患者进行动态血压检测 ,观察血压控制情况。1　资料和方法1 1　资料 :高血压组 :从 2 0 0 1 4～ 2 0 0 1 1 0来本院疗养的离休老干部中随机抽取 1 0 0例降压治疗中的高血压病患者 ,符…     

海捷亚治疗高龄高血压患者疗效和耐受性的研究

目的高龄患者由于肝肾功能的减退,常规剂量药物治疗往往会带来更多的不良反应。本文旨在评价应用常规剂量海捷亚（氯沙坦50mg。氢氯噻嗪12．5mg固定复方制剂治疗高龄高血压患者的降压疗效,对血钾、尿酸、肾功能等的影响及不良反应。方法63例≥80岁的高龄高血压患者。对照组为54例年龄在65—79岁的老年高血压患者。两组均给予海捷亚1^#/d,用药4周。测定用药前后血压、血尿酸、血清钾、血肌酐及用药后不良反应。结果：两组用药4周后血压均明显降低,两组间降压幅度没有统计学意义（P〉0．05）。两组治疗前后血清钾、血尿酸、血肌酐变化差异无统计学意义（P〉0．05）,且无明显不良反应。结论海捷亚在高龄高血压患者中降压疗效肯定．不会引起低血压、血钾升高,降低、血尿酸的升高、肾功能减退,没有不能耐受的不良反应。     

降压药物治疗高血压的研究进展

高血压是临床常见且多发的进行性心血管综合征,在老年人群中发生率较高,临床治疗以控制血压为核心,除对患者的饮食、日常行为等危险因素进行防控外,药物降压是最为有效的手段。近年来,降压药治疗高血压的临床研究和实践不断深入,药物治疗方案不断改进,联合用药的应用逐渐增多。笔者就当前高血压的药物治疗研究进展进行综述。     

高血压患者收缩压控制率

目的 了解目前接受药物治疗的高血压患者收缩压达标率，医师对收缩压达标的认识及临床高血压用药情况。方法 采用调查问卷进行横断面调查，内容包括医师(2291人)和患者(8952人)两部分。医师填写患者收缩压达标的比例，干预收缩压最有效的降压药物。患者部分也由医师填写，包括患者的高血压及相关病史，家族史等，检查结果，治疗情况。结果 患者的收缩压达标率57％，而主观认为达标率大于50％的医生约占30％。经过高血压药物治疗，患者的收缩压幅度下降。随年龄、血压水平和危险分层的增加，收缩压降压幅度也相应增加，但是收缩压的达标率相对较低。心肌梗死、心力衰竭和脑卒中患者的收缩压降压幅度较大，控制率也较高。而糖尿病患者，降压幅度较小，控制率也较低。联合用药的患者降压幅度高于单一用药。收缩压下降的同时舒张压也相应下降，血压水平和危险分层高的患者舒张压下降幅度较大。患者平时使用最多的和医师主观上认为的最有效的降压药物都是钙拮抗剂。结论高血压患者经治疗后收缩压下降，高危患者的治疗需要高度重视，且开始治疗即可联合用药。临床高血压用药以钙拮抗剂为主。     

高血压患者收缩压控制率

目的了解目前接受药物治疗的高血压患者收缩压达标率,医师对收缩压达标的认识及临床高血压用药情况.方法采用调查问卷进行横断面调查,内容包括医师(2 291人)和患者(8 952人)两部分.医师填写患者收缩压达标的比例,干预收缩压最有效的降压药物.患者部分也由医师填写,包括患者的高血压及相关病史,家族史等,检查结果,治疗情况.结果患者的收缩压达标率57%,而主观认为达标率大于50%的医生约占30%.经过高血压药物治疗,患者的收缩压幅度下降.随年龄、血压水平和危险分层的增加,收缩压降压幅度也相应增加,但是收缩压的达标率相对较低.心肌梗死、心力衰竭和脑卒中患者的收缩压降压幅度较大,控制率也较高.而糖尿病患者,降压幅度较小,控制率也较低.联合用药的患者降压幅度高于单一用药.收缩压下降的同时舒张压也相应下降,血压水平和危险分层高的患者舒张压下降幅度较大.患者平时使用最多的和医师主观上认为的最有效的降压药物都是钙拮抗剂.结论高血压患者经治疗后收缩压下降,高危患者的治疗需要高度重视,且开始治疗即可联合用药.临床高血压用药以钙拮抗剂为主.     

高龄老年高血压患者夜间血压与靶器官损害相关性研究

目的 探讨高龄老年高血压患者夜间血压控制水平与靶器官损害之间的关系及其干预策略。方法2005年1月至2007年12月仁济医院老年病科就诊208例高龄老年高血压患者（年龄≥80岁），根据动念血压检测结果分为单纯夜间血压控制不良组（n=102）和全天血压控制均在正常范围组（n=106），对患者的临床资料、生化指标、心脏彩超和颈动脉B超榆查结果及降压治疗方案进行分析。结果两组年龄、性别、血肌酐、血尿素氮、尿酸水平的差异均无统计学意义。两组总胆同醇、甘油三酯、空腹血糖、左室相关参数、颈动脉结构血流参数及斑块情况的差异有统计学意义（P〈0．05）；CCB＋ACEI／ARB组合比利尿剂＋ACEI／ARB组合，在高龄老年高血压患者夜间血压水平控制方面更为有效（JP〈0．001）结论高龄老年高血压患者夜间血压水平与左心室肥厚、颈动脉斑块（P〈0．05）正相关；CCB＋ACEI／ARB药物组合在高龄老年高血压患者夜间血压水平控制效果较好。     

Trials in isolated systolic hypertension: An update

Isolated systolic hypertension (ISH) has proved to be a powerful predisposing factor for cardiovascular diseases in the elderly. Recent placebo-controlled interventional trials such as the Systolic Hypertension in the Elderly Program (SHEP), the Systolic Hypertension in Europe (Syst-Eur), and the Systolic Hypertension in China (Syst-China) showed that the lowering of systolic blood pressure using a diuretic- or a calcium antagonist-based treatment is associated with a decrease in cardiovascular events. Antihypertensive therapy was found especially effective in preventing stroke in the elderly with ISH. A slowing in the progression of dementia was observed in patients randomized to a calcium antagonist-based treatment. Patients at high cardiovascular risk such as those with diabetes benefited the most from treatment. In another trial performed in patients with left ventricular hypertrophy (Losartan Intervention For Endpoint Reduction ), a subset of patients had ISH. In those patients, an angiotensin II antagonist-based treatment was superior to a b-blocker-based treatment in preventing cardiovascular complications. The experience accumulated in patients with ISH showed that combination therapy is often required to control blood pressure. Overall, the evidence available today indicates that pharmacologic treatment of ISH markedly improves the outcome of elderly patients.     

Treatment of hypertension in the elderly

Investigation of preventive measures for hypertension and atherosclerosis is a geriatric medicine priority. While the causes of both isolated systolic hypertension and conventional systolic and diastolic hypertension in the elderly are well defined, the benefits of lowering blood pressure are not. Evidence to support the treatment of symptomatic hypertension is convincing for men 60 years of age; it is not for women in this age group. The need to treat hypertension, particularly isolated systolic hypertension in patients above 75 years old, is still not resolved. Isolated systolic hypertension in older patients is at least as strong a risk factor for cardiovascular disease as is diastolic hypertension. Ongoing trials may answer these questions; in the meantime, drug therapy in this group will vary widely. The elderly hypertensive is more likely than the younger hypertensive to have other diseases; diagnosis of these disorders is crucial. Hypertension arising de novo late in life warrants a search for underlying and possibly remedial causes. Antihypertensive drug therapy to relieve symptoms is difficult to justify, because most elderly hypertensive patients are asymptomatic; however, it has been shown to delay morbid and fatal complications of hypertension. Appropriate therapy for the elderly hypertensive must be individualized and should be associated with few or no side effects. The thiazides are the preferred diuretics for long-term treatment of hypertension in the elderly. Beta blockers are attractive because they are cardioprotective, counter the end organ effect of catecholamines and reduce angina; however, some decrease cardiac output, increase peripheral resistance, decrease renal blood flow and cause fatigue.(ABSTRACT TRUNCATED AT 250 WORDS)     

2012年亚太肝病学会慢性乙型肝炎治疗指南解读

在对乙型肝炎病毒(HBV)感染的深入研究和新的抗病毒药物治疗研究的基础上,2012年亚太肝病学会(APASL)对慢性乙型肝炎防治指南进行了更新。本文对指南推荐意见中关于治疗前评估、治疗的目标和治疗终点以及抗病毒药物的应用策略,包括怎样选择药物及治疗监测、如何停药、如何治疗肝硬化及失代偿的患者、如何防止肝移植患者的复发、如何治疗人类免疫缺陷病毒(HIV)和(或)丙型肝炎病毒(HCV)与HBV重叠感染的患者、如何治疗妊娠患者及如何治疗应用免疫抑制剂及化疗药物的患者等进行解读。     

The importance of systolic blood pressure control and cardiovascular disease prevention

Opinion statement Hypertension affects up to 75% of individuals 60 years of age and older. Cardiovascular risk is related to increases in systolic blood pressure and pulse pressure and to decreases in diastolic blood pressure, but systolic blood pressure reduction is the major target for improving outcomes in the elderly patient. Hypertension therapy in older individuals should include lifestyle modification, especially weight loss and sodium restriction, which may decrease the need for antihypertensive medication. The starting dose of medication should be one half that used in younger patients. If low initial doses are used, significant attention must be paid to adequate titration; combination therapy is usually required for optimal blood pressure control. The initial agent chosen is rarely the final agent used to achieve the recommended minimal systolic blood pressure goal of less than 140 mm Hg. If more than one agent is required, a diuretic should be included as one of the agents chosen. Although the reduction of blood pressure should occur more gradually in the older patient, the treatment goals should be similar and determined by the underlying concomitant disorder. The minimum goal should remain less than 140/90 mm Hg, with lower goals in diabetic patients and those with renal disease. Patients with isolated systolic hypertension should have a minimum systolic blood pressure goal of less than 140 mm Hg.     

Hypertension in the Elderly

Hypertension as a risk factor for cardiac and cerebrovascular morbidity and mortality poses a major health problem for our increasingly elderly population. Recent trials have shown large reductions in stroke, heart failure, and coronary artery disease when elderly hypertensive patients are treated. These benefits are also seen in elderly patients with isolated systolic hypertension. The elderly patient with hypertension should be investigated and managed in a similar manner to their younger counterpart. Nonpharmacological measures, such as dietary salt and calorie restriction, regular exercise, cessation of smoking, and reduction of excess alcohol intake, should be recommended. If these are insufficient, pharmacological treatment should be tailored to the individual patient. Diuretics have been shown to improve outcome measures in the elderly. Other antihypertensive drugs may be added or substituted depending on the patient's blood pressure response to therapy and their comorbid conditions. If all elderly hypertensive patients were treated, a major reduction in cardiovascular and cerebrovascular mortality and morbidity would result. Consideration also needs to be given to nonpharmacological treatment, particularly salt restriction in older subjects where blood pressure is at the upper limit of normal, as this would also result in a major reduction in cardiovascular morbidity and mortality.     

Current status and characteristics of hypertension control in community resident elderly Korean people: data from a Korean longitudinal study on health and aging (KLoSHa study).

Hypertension is a common disease that greatly impacts the health of the elderly. However, the status of blood pressure (BP) control in the elderly Korean population has not yet been investigated. Subjects aged 65 years or older living in Seongnam city, a suburb of Seoul, Korea, were included in this study. All subjects were evaluated by a physician, and medication was reviewed by a nurse. Seated BPs were measured by a trained nurse using standard methods. A total of 995 subjects were included in the current analysis (mean age: 76.3+/-8.7 years). The prevalence of hypertension was 68.7% in the study population, and this value increased with age, peaked in the 75-84 age group, and decreased thereafter. Only 66.1% of hypertensive patients had taken any antihypertensive medication, among which calcium channel blockers (64.2%) were most commonly used. Among the patients on antihypertensive medication, 46% were on combination drug therapy. BP was controlled in 38.5% of hypertensive patients, with systolic BP less controlled than diastolic BP, especially in the oldest-old population. The BP control rate was lower in high-risk patients of diabetes and renal disease. In conclusion, in community resident elderly populations, the BP control rate remains unsatisfactory, especially in high-risk patients. The benefit and optimal level of BP control in oldest-old population must be investigated because a lot of elderly hypertensive patients are currently being managed without definite evidence of related benefits.     

Efficacy and safety of guanadrel in elderly hypertensive patients

Hypertension is common in the elderly and is associated with higher morbidity and mortality, which may be decreased by effective blood pressure control. Many antihypertensive drugs, however, are not well tolerated by the aged. We treated 21 patients (ten men and 11 women) between ages 65 and 84 years (mean, 73.6 years) with guanadrel sulfate. All patients had received prior antihypertensive therapy, which either was ineffective or caused undesirable side effects. Average follow-up time was 17 months. Mean systolic pressure on enrollment was 188 +/- 17 mm Hg and mean diastolic pressure was 100 +/- 10 mm Hg. After treatment, the mean systolic pressure was 139 +/- 15 mm Hg and mean diastolic pressure was 82 +/- 8 mm Hg. Dosage varied from 5 to 30 mg/d with a mean of 16 mg/d. The only significant side effects were fatigue, dizziness, and dyspnea reported in four patients. Eleven patients took the medication as monotherapy and ten received diuretics or diuretics and beta-blockers as additional therapy. Our conclusion is that guanadrel is an effective, well-tolerated medication for treatment of hypertension in the elderly.     

Reasons for adherence with antihypertensive medication

BACKGROUND: Hypertension is often insufficiently controlled in clinical practice, a prominent reason for this being poor patient adherence with therapy. Little is known about the underlying reasons for poor adherence. We set out to investigate hypertensive patients' self-reported reasons for adhering to or ignoring medical advice regarding antihypertensive medication. METHODS: Qualitative analysis of semi-structured interviews with 33 hypertensive patients in a general-practice centre and a specialist hypertension unit in Southern Sweden. Blood-pressure measurements and laboratory measurements of antihypertensive medication were performed. RESULTS: Nineteen out of 33 patients were classified as adherent. Adherence was a function of faith in the physician, fear of complications of hypertension, and a desire to control blood pressure. Non-adherence was an active decision, partly based on misunderstandings of the condition and general disapproval of medication, but mostly taken in order to facilitate daily life or minimize adverse effects. Adherent patients gave less evidence of involvement in care than non-adherent patients. There was no obvious relation between reported adherence, laboratory markers of adherence and blood-pressure levels. CONCLUSIONS: The interview is a powerful tool for ascertaining patients' concepts and behaviour. To optimize treatment of hypertension, it is important to form a therapeutic alliance in which patients' doubts and difficulties with therapy can be detected and addressed. For this, effective patient-physician communication is of vital importance.     

How far Should we Lower Blood Pressure in the Elderly

In the last few years several large intervention trials have addressed the treatment of hypertension in the elderly and how far blood pressure should be lowered in such patients. The positive results of intervention against high blood pressure in the elderly has resulted in a positive attitude towards treatment and today this is an accepted and highly effective medical intervention. Both stroke and coronary morbidity have been shown to be positively affected as has total mortality. The specific issue, how far to lower blood pressure in the elderly was probably best addressed in the Hypertension Optimal Treatment (HOT) stduy in which about a third of the patients, i.e. > 6,000 patients, were 65 years of age.In most of the early intervention studies of antihypertensive treatment in elderly patients diuretics or ß-blockers or the two in combination were used as the therapy by which blood pressure was lowered. However, novel therapies, in particular calcium antagonists, have shown benefits of the same magnitude as the older therapies, e.g. in the STONE trial, the Syst-Eur study, the Syst-China study and the STOP-Hypertension-2 study. In the latter study a regimen based on either of two ACE inhibitors was also shown to be equally effective as conventional treatment, based on diuretics and/or betablockers, in the elderly. These trials will be briefly reviewed here as will the SCOPE study which is an ogoing trial in which hypertensive patients aged 70–89 years are being treated with an angiotensin II receptor antagonist under double-blind and placebo-controlled conditions.It can be concluded that a wealth of information, based on large intervention trials, has been accumulated during the last decade. It is quite obvious that the elderly hypertensive patients benefit from antihypertensive treatment to at least the same extent as the young and middle-aged. It appears that blood pressure ought to be lowered down to normotensive values also in the elderly in order to minimize their risk if cardiovascular complications, although more studies would be welcome to address this issue specifically in the elderly.     

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??Abstract??The elderly CKD patients constitute the fast-growing population reaching end-stage renal disease (ESRD) and commencing dialysis therapy.Peritoneal dialysis (PD) has many advantages on elderly patients such as home-based therapy??relatively stable hemodynamics??etc.However??elderly patients have multiple complicated disorders and are more susceptible to malnutrition??which are very important prognostic factors for survival of patients.A high burden of physical and cognitive impairment in elderly patients may increase the risk of peritonitis and technique failure.Intensive care should be taken to cope with the comorbidities and malnutrition in the elderly.Offering assisted peritoneal dialysis to unstable or frail elderly ESRD patients will help to perform the procedure at home and improve the technique survival.All these strategies for the care of elderly PD patients will result in better survival and quality of life.