hypertensionintheelderly老年高血壓治療中的一些問題-文庫(kù)吧資料
2024-10-20 15:46本頁(yè)面
【正文】 亡率以及總死亡率顯著高于同齡正常人 ? 中國(guó)人群腦卒中發(fā)生率遠(yuǎn)高于西方人群，老年人由于血管彈性差、自動(dòng)調(diào)節(jié)功能減弱，更易發(fā)生腦卒中 老年高血壓的治療 ? 有高血壓研究證明降壓治療可降低腦卒中、心力衰竭3040%，心肌梗死 25%，延緩認(rèn)知功能減退的進(jìn)展 ? 已有證據(jù)證明血壓與老年生存率的關(guān)系 ? 大多數(shù)高血壓試驗(yàn)排除了有合并疾病的老年人 ? 低血壓，特別是舒張壓過低生存率低 ? 藥物治療的耐受性較年輕人差 Benefitsstudies (1) ? ANBP Study (Oz) recruited 6083 pat aged 6484. ? Randomised to enalapril or HCT follow up for median time of years ? Compared to HCT, the hazard ratio for any CV event was in the ACE group ? But: the protection of the ACE inhibitor was only significant in men ! Benefitsstudies (2) ? SCOPE trial (Study of COgnition and Prognosis in the Elderly) had 5000 pat aged 7089 years with SBP 160180 or DBP 9099 ? Randomised to candesartan or diuretic ? In candesartan group reduction of MAP of 22 mmHg against 18 in diuretics ? Marked reduction in stroke in candesartan but no decrease in overall CV event rate ? Cognitive functional decline similar in both groups over the years of follow up Benefitsstudies (3) ? HYVET (HYpertension in the Very Elderly Trial) very recently finished ? 4000 Patients over 80 with SBP 160 ? Randomised to indapamide mg or placebo ? If needed perindopril was added in treatment group ? 21% reductions of death from any cause, CV deaths reduced by 23%, Stroke by 30%, Heart failure by 64% over 2 years with a MAP reduction of 15 mmHg ? In a 5 year follow up the advantages of treatment are less obvious 老年高血壓血壓應(yīng)降到多少？ Trial Starting BP Final SBP HOT 170 140
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