老年肺纤维化低氧血症病理生理特点

老年呼吸道疾病的发生随着年龄的增长而增多。特发性肺纤维化(IPF)好发于中老年。近年其发病率明显增加。IPF本身的预后很差，如在COPD基础上同时发生特发性肺纤维化，病情更加严重，预后更为恶劣。IPF的最终结果是广泛的肺纤维化、即疤痕组织。由此引起的疤痕癌、肺泡细胞癌、腺癌等相对增多，与吸烟没有直接关系。     

老年高血压的特殊临床问题

发生于老年患者的高血压，其血流动力学，临床特点及预后均不同于其他年龄的高血压患者，为引起临床工作者的重视，本文对老年高血压作简要综述。１老年高血压的病理生理１．１老年人收缩压和舒张压分离现象：正常情况下，收缩压和舒张压均随年龄增加而逐渐升高。５０至６...     

老年肺纤维化的临床与低氧血症的病理生理特点

老年肺纤维化的临床与低氧血症的病理生理特点侯杰曹敏南京大学医学院附属鼓楼医院（２１０００８）特发性肺纤维化（ＩＰＦ）好发于中老年，近年其发病率明显增加。由于吸烟及大气污染等各种因素，老年人慢性阻塞性肺病（ＣＯＰＤ）以及支气管哮喘的发病率亦明显增加。Ｉ...     

老年外科病人病理生理特点

老年人生理机能出现退行性改变 ,是衰老过程的反映 ,随着老龄化的进展 ,主要器官系统的功能储备减退十分明显。加之病人的慢性疾病或未显现的亚临床疾病 ,使得老年人维持机体内稳态的储备力下降。手术创伤造成代谢需求的剧增 ,应激反应给许多器官、系统增加了负担 ,一旦应激引起的改变超出机体的储备能力 ,则可以导致不良后果。本文就老年人心、肺、肾、脑代谢方面的病理生理改变特点讨论围手术期处理的相关问题。1　心血管系统　　随着老龄化的进程心血管系统可出现一系列生理及病理性改变。老年人心肌收缩力减弱 ,心输出量降低 ,易发生体…     

肾实质性高血压的病理生理及治疗

本文综述肾脏与高血压的关系,其中着重介绍肾实质性高血压的病理生理及其治疗进展。     

老年高血压的病理生理学特征与降压药的再评价

老年高血压（ＥＨ）不仅发病率特别高，而且病理生理学改变和药效学特征与年轻人高血压病（ＹＨ）有很大差别，如血浆容量较低，血管阻力较高，心脏指数较低，单纯性收缩期高血压（ＩＳＨ）较多，血浆肾素活性较高，以及并发症和伴发病较多等，这些差别决定了很多对ＹＨ有效的药物不能用于ＥＨ患者。而第二、三代双吡啶生物、哌唑嗪、卡托普利或乙那普利是当前ＥＨ首选降压药。     

老年高血压患者血浆内皮素水平的观察

内皮素 (ＥＴ)作为细胞因子之一 ,对机体生理及病理有重要作用。目前认为内皮素对心血管有局部和整体的调节作用 ,影响血管张力与血压 ,而在老年患者中的影响有何特点有待观察。本文检测60例原发性高血压 (ＥＨ)患者血浆ＥＴ水平 ,并将非老年组和老年组ＥＨ患者的ＥＴ水平做比较 ,报道如下。1　对象和方法1.1　对象1.1.1　ＥＨ组 :选择 1999年 5月～ 2 0 0 0年 5月符合 1999年ＷＨＯ/ＩＳＨ诊断标准的门诊及住院ＥＨ患者 60例 ,其中 <60岁 3 0例 (平均年龄 5 3 1岁 ) ,≥ 60岁 3 0例 (平均年龄69 3岁 )。高血压 1～ 2级 43例 ,3级 17例。均…     

慢性肾脏病合并高血压的病理生理基础及治疗

慢性肾脏病(CKD)患者合并高血压临床常见。大约40%的CKD2期患者[肾小球滤过率(GFR)处于60~90ml/min·1·73m2之间]合并高血压(血压>140/90mmHg)。随着GFR下降,高血压发病率进一步增高,GFR<30ml/min·1·73m2的患者高血压发病率超过75%(图1)[1]。高血压发病率随GFR下降而升高的机制主要包括容量增加、交感神经和肾素-血管紧张素-醛固酮系统(RAAS)的亢进、甲状旁腺功能亢进、血管顺应性改变或血管壁钙化、肾血管疾病(包括大血管和小血管),以及一些内生物质如尿酸、半胱氨酸、前列腺素和内皮素等在体内的变化[2]。CKD患者高血压的发…     

Treatment of hypertension in the elderly

Summary Treatment of hypertension in the elderly is beneficial, and benefit exceeds risk, but in some individuals it may be difficult to decrease blood pressure to goal or normotensive levels. Recent data suggest that the use of diuretics and, in some instances, beta-adrenergic inhibitors will reduce morbidity and mortality in elderly hypertensives and will probably not alter metabolic parameters to a clinically significant degree in most individuals.     

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。     

Longitudinal analysis of blood pressure trends and prognosis in isolated systolic hypertension in elderly individuals

BACKGROUND: With age, a larger proportion of elderly individuals have isolated systolic hypertension (ISH). However, because of a lack of longitudinal studies, much less is known about the incidence and prognosis of ISH in elderly individuals. The aims of this study were to document blood pressure (BP) trends in development of ISH in elderly individuals, and to investigate the incidence and prognosis for those with ISH. METHODS: Retrograde longitudinal analysis was conducted on 3284 subjects during 1958 to 1984. The presence of ISH in elderly individuals was defined as systolic BP of >or=160 and diastolic BP of or=60 years. Prognosis was subsequently investigated until 2002 and compared with that for age- and sex-matched non-ISH control subjects. RESULTS: Selected as ISH in elderly individuals were 185 subjects. Three subtypes were documented by BP trends: 71 subjects with "de novo" ISH, 68 with "burned out" ISH, and 46 subjects with "unclassifiable" ISH. Incidence of ISH increased with age. Mean onset age of ISH was 71.0 years. Subsequent follow-up revealed that the subjects with ISH lived long lives: 83.2% of ISH subjects and 76.2% of control subjects lived to be >80 years old. However, 58.9% of ISH subjects were found to have cardiovascular disease during the follow-up, showing a higher prevalence than among control subjects (42.2%, P = .0013). In more than 40% of subjects with ISH, cardiovascular disease occurred at >or=80 years of age. CONCLUSIONS: In this study, the incidence of ISH increased with age. Persons with ISH have good prognoses in terms of longevity, but many have late-onset cardiovascular complications, suggesting the importance of BP control even in very elderly individuals.     

老年高血压的临床特点

老年高血压患者是一个特殊的人群,血压变化具有自身的特征：如收缩压升高、脉压差增大、血压波动范围大;同时老年高血压患者靶器官损害常广泛存在,并发症多见。这些临床特征影响老年高血压患者的预后,是临床管理中特别需要关注的。     

Associated factors and hemodynamic characteristics of resistant hypertension in the elderly

The purpose of this study was to explore the associated factors and hemodynamic characteristics of resistant hypertension (RHTN) in the elderly. A total of 283 patients aged ≥60 years with hypertension were evaluated by the CNAP™ monitor. Among them, 240 patients were non-RHTN (controlled hypertension with use of three or fewer antihypertensive medications) and 43 patients were RHTN (uncontrolled hypertension despite the concurrent use of ≥3 antihypertensive drugs at optimized doses, including a diuretic, or achieving target blood pressure with the use of ≥4 antihypertensive medications). RHTN was associated with higher body mass index (BMI), longer hypertension duration, and coronary heart disease (p = .004, p < .001, and p = .042, respectively). The mean number of antihypertensive medications was greater in patients with RHTN (p < .001). Hemodynamic analysis revealed higher cardiac output in the RHTN group than in the non-RHTN group, while no difference was observed in systemic vascular resistance. Screening for secondary etiology showed that, among the 43 patients with RHTN, 8 (18.6%) had chronic kidney disease, 8 (18.6%) had obstructive sleep apnea, 4 (9.3%) had primary aldosteronism, 2 (4.7%) had renovascular disease. No significant differences were observed in the cardiac output and systemic vascular resistance values between different causes of RHTN. These findings suggest that higher body mass index, longer hypertension duration, and coronary heart disease emerged as the associated factors of RHTN in the elderly. RHTN is characterized by higher cardiac output. Screening for the possible secondary etiology of RHTN in the elderly patients is necessary and important.     

老年高血压降压治疗目标值争议

一直以来,临床研究和实践中对老年患者降压治疗的目标值存在着争议。随着HYVET研究的公布,以及近年来对降压治疗J型曲线的认识,目前高血压指南和临床认识趋于一致：老年患者可从降压治疗中获益,降压目标值不宜过低;同时强调个体化治疗。     

Optimal treatment of hypertension in the elderly: A Korean perspective

With the progression of the aging population, common diseases of the elderly have become the center of attention in most developed countries. Hypertension is one of the most common morbid conditions in the elderly and has a great impact on their health status because it is the main risk factor of cardiovascular and cerebrovascular diseases. However, a considerable amount of uncertainty remains regarding hypertension in the elderly, such as the benefits of hypertension control in oldest-old populations, the optimal level of blood pressure control, and the efficacy of antihypertensive drugs for the prevention of cognitive dysfunction. While there are many controversial issues concerning the optimal management of hypertension in the elderly, the number of elderly hypertensive patients that require treatment is expected to increase due to the aging population. As a result, knowledge regarding the mechanisms of hypertension in the elderly and specific consideration in managing hypertensive elderly patients are needed to improve the clinical outcome. Furthermore, new therapeutic interventions that are aimed at attenuating age-related vascular changes should be investigated, because hypertension in the elderly, especially isolated systolic hypertension has specific characteristics of increased arterial stiffness in most cases.     

缬沙坦治疗老年人单纯收缩期高血压的临床研究

目的研究缬沙坦对老年单纯收缩期高血压患者的降压作用及其对心血管系统的影响。方法49例老年单纯收缩期高血压患者,平均年龄（76.2±6.0）岁。受试对象均给予缬沙坦80～160mg或加用利尿剂氢氯噻嗪12.5mg治疗,疗程为12个月。治疗前后分别作诊室随测血压、24h动态血压监测、心脏超声检查、颈动脉、椎动脉、肾动脉超声和眼动脉超声检查。结果（1）缬沙坦治疗12个月以后,患者诊室随测收缩压显著下降（P〈0.05）;但24h总体血压、白天及夜间血压均无明显变化;（2）左室短轴缩短率显著升高（P〈0.001）;（3）颈动脉、椎动脉和肾动脉搏动指数（PI）、阻力指数（RI）显著下降（P〈0.05）,肾段间动脉及眼动脉PI及RI无明显变化。结论缬沙坦可有效控制老年单纯收缩期高血压患者诊室血压,并改善其左室收缩功能和动脉顺应性。     

Efficacy and safety of renal denervation in elderly patients with resistant hypertension

Background : Catheter‐based renal sympathetic denervation (RD) causes significant blood pressure (BP) reductions in patients with resistant hypertension (rHTN). However, hypertensive elderly patients reportedly have a lower sympathetic tone than younger patients and a BP lowering effect of RD in this population has not yet been demonstrated. The purpose of this study was to assess the efficacy and safety of RD in elderly patients. Methods : We reviewed all consecutive patients aged ≥ 75 years (mean: 78 years) with rHTN treated with RD. Twenty‐four patients were included in this prospective study. Office and ambulatory BPs were assessed at baseline and 6‐months follow‐up. Primary endpoint was the change in office systolic BP at 6 months. Results : Baseline mean office BP was 173/86 ± 21/13 mm Hg. Baseline 24‐hr mean ambulatory BP, available in 22 patients, was 158/80 ± 20/13 mm Hg. Baseline creatinine was 1.0 ± 0.18 mg/dl and mean number of antihypertensive agents at baseline 4.3 ± 1.4. No device‐ or procedure‐related adverse events occurred. At 6‐months follow‐up, the mean office BP decreased by 19/11 ± 29/16 mm Hg (P < 0.01 compared to baseline). Mean systolic 24 hr ambulatory BP, available in 17 patients, decreased by 9/5 ± 13/13 mm Hg. Antihypertensive medications could be reduced in nine patients. Furthermore, renal function was not impaired. Conclusion : According to our findings, a similar magnitude of BP reduction as reported in previous trials can be expected in elderly patients. Elderly patients with rHTN should not be excluded from renal denervation. © 2015 Wiley Periodicals, Inc.