基于老年高血压病临床治疗的思考

高血压病是严重危害老年人健康的常见病、多发病,也是引起脑卒中、心力衰竭和肾功能损害的重要危险因素。老年高血压的发病机制与中青年高血压不尽相同,具有单纯收缩期高血压多见、血压波动大、脉压大、并发症多、靶器官损害明显等临床特点,而且其三高（患病率高、致残率高、病死率高）和三低（知晓率低、治疗率低、控制率低）现象更为突出,给该病的临床治疗带来了困难。目前针对老年高血压的药物治疗主要包括西医、中医以及中西医结合3种方式。西药降压具有作用较强、起效快、作用机制明确的优势,但不良反应相对较多;中药治疗具有副作用少、症状改善明显及多环节起效的优势,但存在降压作用较弱、起效慢、制剂相对落后等方面的不足,且缺乏多中心、大样本、随机、双盲、对照临床试验。基于辨证与辨病相结合的中西医结合治疗方案能够在一定程度上发挥中、西医各自的优势,取长补短,值得进一步研究。

Considerations about treatment programs of elderly patients with hypertension

Hypertension in elderly patients is a common and frequent disease which could cause stroke, heart failure and renal dysfunction. The pathogenesis of hypertension in the elderly is different from that in the young and middle-aged people, and its clinical characteristics including frequent isolated systolic hypertension, variable blood pressure, high pulse pressure, multiple complications, serious target organ damage, and so on. High prevalence, disability and mortality rates and low awareness, treatment and control rates are prominent phenomena in the elderly patients with hypertension, bringing many difficulties for clinical treatment. Presently, drug therapies for elderly patients mainly include Western medicine （WM）, traditional Chinese medicine （TCM）, and integrated traditional Chinese and Western medicine. WM therapy has superiority in lowering blood pressure intensively with clear mechanism, but has more adverse reactions. The effects of TCM therapy are multilinked, and TCM is good at reducing side effects and improving symptoms, but TCM preparation falls behind and its hypotensive effects are weak and slow. Furthermore, more multicenter, randomized, controlled and double-blinded clinical trials with large sample are needed to identify the effects of TCM therapy. Based on combination of TCM syndrome differentiation and WM disease differentiation, treatment programs of integrated traditional Chinese and Western medicine would take advantages of both TCM and WM treatment modalities, and are worthy of being studied in the future.