老年高血压的治疗策略

摘要

Hypertension in the elderly is a major clinical and public health problem. Treatment strategies for hypertension in the elderly include lifestyle improvement and antihypertensive agent treatment to achieve blood target pressure level. Thiazide diuretics, calcium channel blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and β-blockers can be used as the first choice for initiation and maintenance treatment of hypertension in the elderly patients. In general, the treatment strategy for hypertension in the elderly should be considered individually. The starting dosage should be low and the dosage should be titrated gradually. Meanwhile, adverse drug effects, other cardiovascular risk factors and complications should be monitored and managed carefully. The treatment should be continued for a rather long term.%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.