老年高血压的治疗策略

高血压是老年人群中的常见疾病,目前老年高血压已成为重要的公共卫生问题。老年高血压的治疗策略主要为：在改善生活方式等非药物治疗措施的基础上,选择合适的降压药物治疗使血压达标。常用的五类降压药物,噻嗪类利尿剂、钙通道拮抗剂、血管紧张素转换酶抑制剂、血管紧张素受体阻滞剂、β受体阻滞剂均可作为一线降压药物用于老年高血压的起始和维持治疗、单药或优化联合治疗。老年人降压治疗应遵循个体化原则,宜平稳、缓慢,降压药物起始剂量要小,逐渐增加剂量。治疗过程中须注意监测药物不良反应和其他心血管危险因素及合并疾病的治疗,并长期坚持治疗。     

老年人高血压的临床特点及药物治疗进展

高血压是冠心病、心力衰竭以及脑卒中等疾病的高危发病因素。相关数据中显示,在老年人中发病率达到三分之二。老年患者具有特殊的病理生理学特征,其中包括血压波动较大、对神经反射的敏感性较低、体位性低血压发生率较高、血流动力学改变以及合并多脏器功能损伤等,明显降低降压治疗效果。因此老年高血压患者治疗时应积极考虑其特点,从而选择针对性治疗药物,提高治疗效果。本文对此展开综述,分析各类药物的治疗效果。     

老年高血压合并衰弱患者降压治疗的研究进展

高血压是影响老年人健康的重要因素,降压治疗可降低老年高血压患者脑卒中、心血管事件和死亡等风险。老年人群中衰弱常与高血压并存,但目前关于老年高血压与衰弱的研究相对较少,尤其是老年高血压合并衰弱的降压治疗研究结论不一。老年高血压合并衰弱患者降压治疗的起始值与目标值、衰弱老年人能否从降压治疗中获益以及降压治疗方案的选择等仍争议较大。因此,本文对老年高血压患者合并衰弱的降压治疗进行综述。     

衰弱对老年高血压患者血压与预后关系的影响

<正>高血压是老年人常见慢性疾病,也是我国老年人群心脑血管病发病和死亡的最重要危险因素之一。研究证实,降压治疗可明显减少不良心血管事件及死亡风险。然而老年人群的降压治疗研究结果一直存在争议,一些研究显示,老年人降压治疗获益[1-2]。而另一些研究提示,老年人降压并不获益,甚至增加死亡风险[3]。近年来国外学者提出,老年高血压降压治疗的结局不同或与衰弱相关,一些研究发现,衰弱的老年高血压患者其血压降低与死亡风险升高密切相关。     

从近期新指南看老年高血压治疗的新趋势

近年来,各国指南关于老年人高血压的治疗目标值仍然存在争议。本文比较了最新国际指南关于老年高血压控制的目标值和临床试验证据,以探讨老年高血压治疗的新趋势。根据现有循证医学证据,可将老年人群血压控制在150/90mmHg(1mmHg=0.133kPa)以内。老年人高血压监测要多样化,降压目标应个体化,药物选择要优化,遵循个体化原则,平稳、和缓、持久、简化、优化的降压方案是老年高血压治疗的基本策略。     

穴位按摩对老年高血压患者血压及中医证候的影响

<正>目前,我国老年高血压人群的治疗率和血压控制达标率仅为32.2%和7.6%。临床治疗高血压的主要手段是药物降压,但老年高血压患者血压波动大,合并疾病多,药物不良反应增加,大大降低了患者的服药依从性。因此,探寻效果好、安全性高的非药物降压手段意义重大。本研究旨在探究穴位按摩对老年高血压患者血压及中医证候的影响。1资料与方法1.1一般资料选本院2015年1月至2015年10月     

老年冠心病患者的血压和血脂管理

老年人随着增龄,各种心血管病危险因素有逐渐累积其致病性的效果。老年人的各种器官功能逐渐减退,其治防策略有一定的特殊性。以下就老年人的血压和血脂管理作一简要介绍。老年冠心病患者从降压治疗获益更大,但是老年人收缩压增高,而舒张压降低,脉压因而增大,同时血压波动较大,昼夜节律变化较大,合并的疾病较多,因而要格外注意平稳降压。老年冠心病患者血脂异常同样可以从降脂治疗获益,但是由于老年人各种内脏功能均有不同程度减退,且常合并多种疾病,用药较多,易发生不良反应,应严密监测肝功异常和肌病的发生。     

缬沙坦联合氨氯地平治疗老年高血压的疗效观察

老年性高血压危害老年人的身体健康,其主要并发症有心肌梗死、脑卒中等.单一药物很难使老年高血压患者的血压达到一定的目标值,联合用药不仅能使血压达标,还可增加降压效果.我们观察比较缬沙坦联合氨氯地平治疗老年高血压的临床疗效,取得满意的效果,现报告如下.     

老年人高血压

老年人是高血压的易感人群。以往对老年高血压的降压治疗持较为谨慎的态度,认为老年人血压轻度升高是一种生理现象,对其血压控制的目标值掌握较宽松。近年来,随着一系列大规模临床试验的陆续揭晓,高血压的防治观念不断更新,人们对老年人高血压有了新的认识。1定义及流行病学欧美国家一般以65岁为老年的界限。中华医学会老年医学会于1982年根据世界卫生组织西太平洋地区会议所定标准提出我国老年界限为≥60岁。高血压患病率随着年龄的增长而显著增高,许多高血压患者需要降压治疗〔1〕。近期Framingham心脏研究资料显示,高血压患病率和血压升…     

吲哒帕胺联合阿罗洛尔对老年高血压患者的疗效观察

高血压是老年人常见病,现已成为老年人死亡、致残最严重的疾病之一。老年高血压人群也是高血压控制率最低的人群之一,选择合理的治疗药物和用药方案是提高老年高血压患者血压控制率和达标率的重要课题。本研究旨在观察吲哒帕胺联合小剂量阿罗洛尔治疗老年人高血压的效果,同时观察这种治疗方案对糖脂代谢的影响。     

原发性高血压患者心理干预的疗效观察

目的观察心理治疗在原发性高血压治疗中的作用。方法将210例原发性高血压患者随机分为试验组(130例)和对照组(80例),试验组在口服常规降压药物治疗的基础上,采用心理干预治疗,对照组仅口服常规降压药物。对两组患者进行为期半年的观察,对患者的血压变化以及9O项症状自评量表(symptomchecklist90,SCL-90)评价的结果进行比较。结果高血压患者的心理状态明显比一般人群差,两组患者在心理状态改善和高血压疗效上相比差异均有非常显著性意义(P<0.01)。结论对原发性高血压患者的治疗除常规用药外,还应注重对患者的心理因素采取措施。心理治疗也是治疗高血压的一个重要措施。     

经鼻持续气道内正压通气对阻塞性睡眠呼吸暂停综合征患者血压的影响

阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)是一种睡眠呼吸障碍性疾病,高血压是其最常见的并发症和合并症之一,近年来研究显示,OSAS引起的高血压多为难治性.常规药物降压效果较差.而经鼻持续气道内正压通气可以取得良好的疗效,本文就OSAS与高血压关系及经鼻持续气道内正压通气对OSAS患者血压影响的研究进展作相应综述.     

Excessive weight and hypertension in the elderly - the results of the community study

The purpose of the study was to examine the relationship between excessive weight and systolic-diastolic and isolated systolic hypertension in the elderly. The sample covered 631 men and 1269 women of age 65-84 who took part in the screening program for chest diseases in Cracow city center (Poland). During the visit at the medical center, blood pressure measurements (BP), anthropometric data, as well as standardized interviews on symptoms and current medical treatment have been carried out. The findings show that the prevalence of hypertension, defined as self-reported antihypertension treatment by a doctor and/or blood pressure greater or equal to 160/95, was 32.3% in males and 46.1% in females. Adding the cases of isolated systolic hypertension, the prevalence rates would be 50.5% in men and 68.1% in women. There was strong association between body mass index (BMI) and hypertension, defined by self-reported antihypertension treatment. The association between systolic-diastolic hypertension and BMI was significant only in those persons who denied the treatment. Isolated systolic hypertension appeared not to be significantly related to excessive weight. Hypertension attributable to the excessive weight would be in the range of 38% in men and 41% in women. Beneficial effects of the weight reduction programs should not be expected with regard to isolated systolic hypertension. The data support the clinical opinion that both kinds of hypertension are distinct disorders.     

老年高血压患者控制血压现状及相关问题探讨

目的:调查分析广州疗养院疗养员高血压的降压治疗现状、控制率,探讨血压控制不良原因。方法:对778例原发性高血压患者降压药物应用方案进行登记,并观察血压控制情况。结果:高血压服药率96.66%,控制率76.48%,有针对性治疗后血压有显著改善(P<0.05～<0.01)。血压控制不良原因按百分率排列,依次为服用短效降压药(7.5%)、顽固性高血压(7.2%)、依从性差(6.3%)、白大衣高血压(1.7%)、不良行为方式(1.6%)。结论:针对病因的治疗对血压达标有重要意义。     

北京城乡老年人高血压现状调查

目的了解北京城乡老年人高血压的现状。方法采用分层整群随机抽样方法,选取北京地区年龄≥60岁的老年人2277例进行血压测量及相关资料的收集。结果 2277例老年人中,高血压患者1275例,北京地区老年人高血压患病率为56.0%,知晓率为57.7%,治疗率为56.2%,治疗后控制率为36.4%。结论高血压患病率高,但知晓率、治疗率和控制率较低,必须积极采取有效的措施以降低高血压的患病率,提高知晓率、治疗率和控制率。     

杓型和非杓型轻、中度高血压患者的超声心动图改变

目的 了解具有不同的24h动态血压(ABPM)动态曲线模式的高血压(HT)患者对心血管结构功能的影响。方法 对126例经ABPM测定的轻、中度HT患者进行超声心动图检查。结果 杓型与非杓型HT患者在年龄、性别基本相同,非杓型HT组具有更长的病程和更高的平均动态血压,且该组主动脉、主肺动脉内径有增宽的趋势,非杓型HT组左心室舒张功能轻度受损,两组患者的收缩功能均正常,结论根据ABPM动态曲线模式,可以判断轻中度高血压患者出现心血管异常的可能性及对心脏结构功能的损害程度,为临床上早期预测严重的心血管疾病的发生及降压药的选择、疗效的评价提供客观依据。     

动态血压监测评价高血压患者靶器官损害246例分析

目的探讨动态血压监测对评价高血压患者靶器官损害的价值。方法对246例高血压患者进行24h动态血压监测,其中单纯血压升高118例为原发性高血压组,伴靶器官损害128例为伴靶器官损害组,进行统计学分析。结果(1)伴靶器官损害组24h收缩压、白昼舒张压、夜间舒张压低于原发性高血压组(P<0.01);(2)靶器官损害数目累及3个器官组与累及1个器官组相比,24h平均收缩压、夜间平均舒张压、血压波动的昼夜节律异常和血压负荷参数,差异有统计学意义。结论血压波动的昼夜节律异常、24h平均收缩压、夜间平均舒张压和血压负荷越高,靶器官损害数目越多。     

血管紧张素转换酶基因型与卡托普利疗效的相关性研究

目的 研究原发性高血压患者ACE基因多态性分布与卡托普利疗效的相关性。方法 133名原发性高血压患者按ACE基因多态性的II,ID与DD型三种,同时服用卡托普利25mg bid,服药前后作动态血压监测,以观察在各种不同ACE基因多态性间的区别。结果 ID患者在24小时收缩压,白天收缩压及夜间收缩压的降低程度均较其它型为明显（P＜0．05）。结论：转换酶抑制剂的作用可能与ACE的基因类型有关。     

Task force IV: Clinical use of ambulatory blood pressure monitoring. Participants of the 1999 Consensus Conference on Ambulatory Blood Pressure Monitoring

OBJECTIVE: To reach a consensus on the clinical use of ambulatory blood pressure monitoring (ABPM). METHODS: A task force on the clinical use of ABPM wrote this overview in preparation for the Seventh International Consensus Conference (23-25 September 1999, Leuven, Belgium). This article was amended to account for opinions aired at the conference and to reflect the common ground reached in the discussions. POINTS OF CONSENSUS: The Riva Rocci/Korotkoff technique, although it is prone to error, is easy and cheap to perform and remains worldwide the standard procedure for measuring blood pressure. ABPM should be performed only with properly validated devices as an accessory to conventional measurement of blood pressure. Ambulatory recording of blood pressure requires considerable investment in equipment and training and its use for screening purposes cannot be recommended. ABPM is most useful for identifying patients with white-coat hypertension (WCH), also known as isolated clinic hypertension, which is arbitrarily defined as a clinic blood pressure of more than 140 mmHg systolic or 90 mmHg diastolic in a patient with daytime ambulatory blood pressure below 135 mmHg systolic and 85 mmHg diastolic. Some experts consider a daytime blood pressure below 130 mmHg systolic and 80 mmHg diastolic optimal. Whether WCH predisposes subjects to sustained hypertension remains debated. However, outcome is better correlated to the ambulatory blood pressure than it is to the conventional blood pressure. Antihypertensive drugs lower the clinic blood pressure in patients with WCH but not the ambulatory blood pressure, and also do not improve prognosis. Nevertheless, WCH should not be left unattended. If no previous cardiovascular complications are present, treatment could be limited to follow-up and hygienic measures, which should also account for risk factors other than hypertension. ABPM is superior to conventional measurement of blood pressure not only for selecting patients for antihypertensive drug treatment but also for assessing the effects both of non-pharmacological and of pharmacological therapy. The ambulatory blood pressure should be reduced by treatment to below the thresholds applied for diagnosing sustained hypertension. ABPM makes the diagnosis and treatment of nocturnal hypertension possible and is especially indicated for patients with borderline hypertension, the elderly, pregnant women, patients with treatment-resistant hypertension and patients with symptoms suggestive of hypotension. In centres with sufficient financial resources, ABPM could become part of the routine assessment of patients with clinic hypertension. For patients with WCH, it should be repeated at annual or 6-monthly intervals. Variation of blood pressure throughout the day can be monitored only by ABPM, but several advantages of the latter technique can also be obtained by self-measurement of blood pressure, a less expensive method that is probably better suited to primary practice and use in developing countries. CONCLUSIONS: ABPM or equivalent methods for tracing the white-coat effect should become part of the routine diagnostic and therapeutic procedures applied to treated and untreated patients with elevated clinic blood pressures. Results of long-term outcome trials should better establish the advantage of further integrating ABPM as an accessory to conventional sphygmomanometry into the routine care of hypertensive patients and should provide more definite information on the long-term cost-effectiveness. Because such trials are not likely to be funded by the pharmaceutical industry, governments and health insurance companies should take responsibility in this regard.