Systolic hypertension in older persons: complexities in clinical decision making.

摘要

While the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) challenges clinicians to aggressively manage systolic hypertension, few data are available to guide clinicians in treating older persons with this condition. In older persons, hypertension treatment decisions must often rely on extrapolations and fall into a gray area where optimal choice for an individual patient may be unclear. In these instances, patients must understand the probable outcomes of options, consider the personal value they place on benefits vs. risks, and participate with their practitioners in deciding on treatment. Shared decision making is the process by which the health care provider and patient share all stages of the decision-making process and both discuss treatment preferences and agree on a final management plan. Our challenge as clinicians is to ensure that all older patients have the opportunity to be treated in a way that is evidence-based and patient-centered. As with most health care decisions in older persons, those regarding blood pressure control should promote evidence-based care that is complementary with individualized risk, benefit ratios, patient preferences, and treatment goals.