离退休干部门诊高血压和高血脂及高血糖临床分布情况观察

目的对离退休干部高血压、高血脂、高血糖的临床流行病学资料进行收集和分析,为加强医疗保健工作提供科学依据。方法全部1 560例病例资料来自首都医科大学附属北京朝阳医院干部门诊。回顾性分析离退休干部高血压、高血脂、高血糖的患病构成比、治疗率和控制率。结果患高血压、高血脂、高血糖从高到低分别为高血压(76.9%)、高血脂(46.6%)、高血糖(29.4%)。同时患有2种疾病的比例较高(42.7%)。高血糖患者合并代谢综合征比例较高(62.0%)。常见的合并疾病依次为脑卒中、冠心病和恶性肿瘤。高血压患者血压控制率明显高于高血糖患者血糖控制率(85.3%vs77.9%,P<0.01)。结论离退休干部门诊就诊的高血压、高血脂、高血糖比较常见。且随年龄增长,呈上升趋势,高血脂患者有年轻化趋势。易合并心脑血管疾病。     

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.     

Heart failure in the elderly

Heart failure is common in the elderly population. Approximately 6 to 10 percent of the population 65 years or older have heart failure. Heart failure is the most common reason for hospitalization in elderly patients. Etiology of heart failure is often multifactorial in the elderly. The common causes of heart failure include ischemic heart disease, valvular heart disease, hypertensive heart disease, and cardiomyopathy. Exacerbation of heart failure in the elderly is often accompanied by precipitating factors which include arrhythmia, renal failure, anemia, infection, adverse effect of drugs and non-compliance with medication and/or diet. Diagnosis of heart failure may be difficult in the elderly because symptoms of heart failure are often atypical or even absent. Heart failure with preserved systolic function is common in the elderly because aging has a greater impact on diastolic function. It is important to recognize that very old patients with heart failure are underrepresented in clinical trials.     

Reducing the risk of stroke: identifying patients to refer for carotid endarterectomy

The most common causes of stroke are two diseases of aging: hypertension and atherosclerosis. Therefore, although stroke may occur at any age, the incidence is highest among the elderly population. Noninvasive efforts to reduce the risk of stroke in the elderly include control of hypertension and diabetes, smoking cessation, low-cholesterol dietary habits, and moderate exercise. Routine low-dose aspirin also provides some protective effect. High-risk patients (with asymptomatic high-grade stenosis, TIAs, or prior stroke) should be considered candidates for carotid endarterectomy in the absence of contraindications to surgery.     

Geriatric hypertension: antihypertensive therapy in coronary artery disease

Systemic hypertension is a common clinical problem in the elderly. There is emerging evidence to suggest that with careful utilization of antihypertensive drugs, blood pressure can be lowered in the elderly population. Whether isolated systolic hypertension should be treated aggressively remains an unanswered question despite the evidence that systolic hypertension can cause certain cardiovascular complications. An elderly patient with hypertension and concomitant coronary artery disease merits proper blood pressure control with appropriate drugs to prevent progression of coronary disease. The therapeutic objective is not only to lower the blood pressure but to accomplish this goal with drugs which are likely to have a favorable effect on coronary artery disease. Changing trends in the drug therapy of hypertension indicate that calcium antagonists and beta-blocking drugs offer a therapeutic advantage in elderly hypertensive patients with coronary artery diseases.     

Hypertension in the aging patient. Implications for the selection of drug therapy

Although earlier debates had questioned the wisdom of treating hypertension in elderly patients, it is now becoming apparent that such treatment is warranted. Systolic hypertension, which prevails in this population, is more closely correlated to hypertensive complications than is diastolic blood pressure. Recent multicenter trials have demonstrated that in this age group, as in younger patients, control of hypertension can significantly decrease the rate of cardiovascular and cerebrovascular events. Many effective antihypertensive agents are available today, but elderly patients, because of their hemodynamic and biochemical characteristics, are particularly vulnerable to the common side effects of most drugs. However, the two newer classes of drugs (the angiotensin-converting enzyme inhibitors and the calcium channel blockers) offer several advantages in terms of favorable hemodynamic and biochemical profiles, convenience of dosing, and maintenance of quality of life. These characteristics justify choosing these agents as first-line therapy for hypertension.     

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)     

Benefits and risks of antihypertensive medications in the elderly

Hypertension is highly prevalent in older age and accounts for a large proportion of cardiovascular (CV) morbidity and mortality worldwide. Isolated systolic hypertension is more common in the elderly than younger adults and associated with poor outcomes such as cerebrovascular disease and acute coronary events. International guidelines are inconsistent in providing recommendations on optimal blood pressure targets in hypertensive elderly patients as a result of the limited evidence in this population. Evidence from clinical trials supports the use of antihypertensive drugs in hypertensive elderly patients due to benefits in reducing CV disease and mortality. However, elderly participants in these trials may not be typical of elderly patients seen in routine clinical practice, and the potential risks associated with use of antihypertensive drugs in the elderly are not as well studied as younger participants. Therefore, the purpose of this review was to provide a comprehensive summary of the benefits and risks of the use of antihypertensive drugs in elderly patients (aged ≥65 years), highlighting landmark clinical trials and observational studies. We will focus on specific outcomes relating to the benefits and risks of these medications in hypertensive elderly patients, such as CV disease, cognitive decline, dementia, orthostatic hypotension, falls, fractures, cancer and diabetes, in order to provide an update of the most relevant and current evidence to help inform clinical decision‐making.     

Impaired endothelial function in hypertensive elderly patients evaluated by high resolution ultrasonography.

BACKGROUND: Multiple investigations both in experimental models and in middle-aged patients with essential hypertension have demonstrated impaired endothelium-dependent vasodilation. OBJECTIVE: To determine whether hypertension exerts an additional negative effect on endothelial function of large arteries in hypertensive elderly patients who may already be affected by endothelial dysfunction due to aging. PATIENTS AND METHODS: Thirteen elderly patients with hypertension (69 9 years of age [mean SD]) were compared with 13 matched healthy elderly subjects (72 6 years of age). High resolution vascular ultrasound was used to measure brachial artery responses to reactive hyperemia (with increased flow causing endothelium-dependent dilation) and to sublingual nitroglycerine (causing endothelium-independent dilation). RESULTS: Flow-mediated diameter (FMD) was significantly impaired in the hypertensive elderly group (6.7 3.3% versus 13.3 3.8% in the control group, P<0.05). No significant difference could be found in nitroglycerine-induced dilation between the elderly control group (12.1 4.9%) and the hypertensive elderly (10.2 6.8%). On simple linear analysis, FMD was inversely correlated with age (r=-0.60, P=0. 03) in the healthy elderly group. FMD in the hypertensive elderly was inversely related to age (r=-0.41, P=0.04) and mean blood pressure (r=-0.67, P=0.01). CONCLUSIONS: This study showed decreased FMD with aging even in the healthy elderly, with a further decline in hypertensive elderly compared with healthy elderly subjects. This impairment of FMD in the hypertensive elderly group was related to age and mean blood pressure, indicating that aging and hypertension may impair endothelial function in the brachial artery of elderly patients with hypertension.     

Envejecimiento y enfermedades del hígado

Liver diseases in the elderly have aroused less interest than diseases of other organs, since the liver plays a limited role in aging. There are no specific liver diseases of old age, but age-related anatomical and functional modifications of the liver cause changes in the frequency and clinical behavior of some liver diseases compared with those in younger patients. This review discusses the most important features of liver function in the healthy elderly population, as well as the features of the most prevalent liver diseases in this age group, especially the diagnostic approach to the most common liver problems in the elderly: asymptomatic elevation of serum transaminases and jaundice.     

Interventional therapies for heart failure in the elderly

The aging of a population replete with risk factors for heart failure (HF) (coronary heart disease, diabetes, and hypertension) coupled with a declining age-adjusted mortality rate for coronary artery and hypertensive heart diseases has created, and will continue to create, a literal explosion in the prevalence of HF in the United States. Despite advances in maximal medical therapy, however, most patients who have symptomatic HF can expect functional impairment, interludes of worsening symptomatology, and a shortened lifespan. This article updates the use of interventional therapies for the treatment of elderly patients who have HF caused by coronary artery disease, valvular heart disease, congenital heart disease, myocardial disease, and renal vascular disease.     

Interventional therapies for heart failure in the elderly

The aging of a population replete with risk factors for heart failure(HF) (coronary heart disease, diabetes, and hypertension) coupled with a declining age-adjusted mortality rate for coronary artery and hypertensive heart diseases has created, and will continue to create, a literal explosion in the prevalence of HF in the United States. Despite advances in maximal medical therapy, however, most patients who have symptomatic HF can expect functional impairment, interludes of worsening symptomatology, and a shortened lifespan. This article updates the use of interventional therapies for the treatment of elderly patients who have HF caused by coronary artery disease, valvular heart disease, congenital heart disease, myocardial disease, and renal vascular disease.     

Aging with HIV: a practical review

The worldwide elderly population is expected to grow by an additional 694 million people by 2025. By that time, there will be approximately two billion elderly people in the world, most of whom (80%) will be living in developing countries. Based on recent estimates, this population will number over 40 million in 2030 in Brazil and a consequent increase in governmental spending for this population can be expected. Since highly active antiretroviral therapy became available in the mid-1990s, the life expectancy of people living with HIV has increased significantly. Approximately 12 million life years were added to the world between 1996 and 2008 as a consequence of wider access to highly active antiretroviral therapy. In Brazil, the incidence of AIDS among the population aged ≥50 years doubled between 1996 and 2006. The development of antiretroviral therapy has allowed individuals diagnosed at a younger age to live longer, which partially explains the aging tendency associated with the HIV/AIDS epidemic. It is estimated that by 2015, subjects aged ≥50 years will represent 50% of the people living with HIV undergoing clinical treatment. This scenario presents some challenges, including the fact that the diagnosis of HIV tends to be delayed in older patients compared to younger patients because the symptoms of HIV can be confused with those of other common diseases among the elderly and also because healthcare professionals do not consider this population to be at high risk for HIV infection. In regard to the individuals diagnosed with HIV, a further challenge is presented by the morbidity normally associated with aging. Finally, the elderly also exhibit higher susceptibility to the toxic effects and pharmacological interactions of medications. The present article reviews the literature regarding the profile of HIV infection among individuals aged ≥50 years focusing on practical features related to the clinical approach and long-term follow-up of this population.     

The Rise and Fall of Hypertension: Lessons Learned from Eastern Europe

Hypertension is a progressive cardiovascular syndrome that arises from many differing, but interrelated, etiologies. Hypertension is the most prevalent cardiovascular disorder, affecting 20% to 50% of the adult population in developed countries. Arterial hypertension is a major risk factor for cardiovascular diseases and death. Epidemiologic data have shown that control of hypertension is achieved in only a small percentage of hypertensive patients. Findings from the World Health Organization project Monitoring Trends and Determinants in Cardiovascular Diseases (MONICA) showed a remarkably high prevalence (about 65%) of hypertension in Eastern Europeans. There is virtually no difference however, between the success rate in controlling hypertension when comparing Eastern and Western European populations. Diagnosing hypertension depends on both population awareness of the dangers of hypertension and medical interventions aimed at the detecting elevated blood pressure, even in asymptomatic patients. Medical compliance with guidelines for the treatment of hypertension is variable throughout Eastern Europe. Prevalence of hypertension increases with age, and the management of hypertension in elderly is a significant problem. The treatment of hypertension demands a comprehensive approach to the patient with regard to cardiovascular risk and individualization of hypertensive therapy.     

老年高血压合并糖尿病临床治疗研究进展

老年高血压合并糖尿病为临床中极为常见的一种疾病,且随着年龄的增长,该疾病的发病率也在逐渐升高,并呈现出年轻化的趋势。我国目前已经进入到人口老龄化快速发展阶段,随着老年人口数量的不断增多,该疾病的发病率也因此不断攀升,患者患病后,会对其生活质量带来严重影响,甚至会并发多种心脑血管系统疾病,严重危害到患者的生命健康。所谓临床常见慢性疾病,患者患病后往往需要接受长期用药,长时间的药物治疗不但会对患者身心健康带来一定的不利影响,同时也会对其家庭经济带来一定的负担。目前临床上针对老年高血压合并糖尿病的治疗工作一直在不断地进行深入研究,该文将围绕疾病的发病机制、临床特点以及常见治疗方法对近些年的研究结果展开综述。     

原发性高血压患者心脏结构和功能改变的流行病学调查

目的:了解北京市合并原发性高血压的住院患者心脏结构和功能改变的特点及相关因素。方法:针对北京地区4 081例原发性高血压住院患者进行流行病学回顾性调查,超声指标包括左心房及左心室内径,室间隔和左心室后壁厚度,E／A比值和左心室射血分数。其他指标包括患者的一般情况、病史和治疗情况。结果:高血压患者左心房扩大和E／A比值异常分别占所有患者的50．6％和70．0％,是高血压心脏损害最常见的两种表现。60～79岁老年人合并各种心脏结构和功能异常的比例均高于中年人。左心房扩大和左心室肥厚呈现出随血压水平升高,异常率增加的趋势。合并心脏结构和功能损害的高血压患者更多的使用联合用药。多因素分析显示,与左心房扩大有关的危险因素有合并心房颤动、肥胖、高龄、高血压病程长以及收缩压增高。与左心室肥厚有关的危险因素同样有高血压病程长、收缩压增高和高龄。与左心室扩大有关的危险因素有女性、合并心房颤动和肥胖。结论:①左心房扩大和E／A比值异常是高血压心脏损害最常见的两种表现;②老年人合并更多的心脏结构和功能损害;③血压水平越高,合并左心房扩大和左心室肥厚者越多;④男性、高血压病程长、收缩压增高和高龄是左心房扩大和左心室肥厚共同的危险因素,合并心房颤动患者合并更多的左心房扩大和左心室扩大。     

Fibromuscular dysplasia of the renal arteries

Although renovascular hypertension is less common than primary hypertension, it is important for clinicians to recognize this clinical entity because of its distinct pathophysiology and specific therapy. It is estimated that about 5% of the overall hypertensive population have renovascular hypertension. Whereas most renovascular lesions are caused by atherosclerosis, stenosis due to fibrous dysplasia is an important disease. In children and young adults, fibromuscular dysplasia of the renal arteries is the most common cause of renovascular hypertension. This review deals with the pathology, clinical characteristics, diagnosis, and therapy of renovascular hypertension associated with fibromuscular dysplasias.     

Fibromuscular dysplasia of the renal arteries

Although renovascular hypertension is less common than primary hypertension, it is important for clinicians to recognize this clinical entity because of its distinct pathophysiology and specific therapy. It is estimated that about 5% of the overall hypertensive population have renovascular hypertension. Whereas most renovascular lesions are caused by atherosclerosis, stenosis due to fibrous dysplasia is an important disease. In children and young adults, fibromuscular dysplasia of the renal arteries is the most common cause of renovascular hypertension. This review deals with the pathology, clinical characteristics, diagnosis, and therapy of renovascular hypertension associated with fibromuscular dysplasias.     

Pathophysiologie der Hypertonie: Was gibt es Neues?

The pathophysiology of primary hypertension is still unresolved and appears more complex than ever. It is beyond the scope of this article to review all new scientific developments in this field. On clinical grounds, hypertension is divided into primary and secondary forms. Here, the authors discuss the pathophysiology of hypertension associated with three common disease entities showing a large overlap with primary hypertension: chronic kidney disease (CKD), obstructive sleep apnea (OSA), and hyperaldosteronism. Especially in CKD and OSA, the activation of the sympathetic nervous system plays a crucial role. It is the authors' belief that hypertension due to these three diseases is more common than previously appreciated and may account for about 20% of the hypertensive population. The knowledge of the underlying pathophysiology allows early diagnosis and guides optimal treatment of these hypertensive patients.     

Evaluation of endothelial function in hypertensive elderly patients by high-resolution ultrasonography.

BACKGROUND: Multiple investigations, both in experimental models and in middle-aged patients with essential hypertension, demonstrate impaired endothelium-dependent vasodilatation. HYPOTHESIS: We attempted to determine whether hypertension still exerts additional negative effect on endothelial function of large arteries in hypertensive elderly patients who may already be affected by endothelial dysfunction due to aging. METHODS: We compared 13 elderly patients with hypertension [69 +/- 9 years, (mean +/- standard deviation)] with 13 matched healthy elderly subjects (72 +/- 6 years) as controls. Using high-resolution vascular ultrasound, we measured brachial artery responses to reactive hyperemia (with increased flow causing endothelium-dependent dilatation) and sublingual nitroglycerin (causing endothelium-independent dilatation). RESULTS: Flow-mediated dilatation correlated inversely with age (r = -0.60, p = 0.03) in the controls. Flow-mediated dilatation was significantly impaired in hypertensive elderly patients (6.7 +/- 3.3 vs. 13.3 +/- 1.8% in controls, p < 0.0001). No significant difference could found in nitroglycerin-induced dilatation between controls (12.1 +/- 4.9%) and hypertensive elderly patients (10.2 +/- 6.8%, p = 0.5). On multivariate analysis, flow-mediated dilatation in hypertensive elderly patients was inversely related to aging (r = -0.37, p = 0.04) and mean blood pressure (r = -0.57, p = 0.03). CONCLUSIONS: Our study showed decreased flow-mediated dilatation with aging even in the healthy controls, and further decline in flow-mediated dilatation in hypertensive elderly patients compared with controls. This impairment of flow-mediated dilatation in hypertensive elderly patients was related to age and mean blood pressure, indicating that aging and hypertension may independently impair endothelial function in the brachial artery of these patients.