Women live longer than men, yet with aging systolic blood pressure and prevalent hypertension increase more, and hypertension control decreases more than in men, i.e., hypertension in older adults is disproportionately a women\'s health issue. Among older adults who are healthy to mildly frail, the absolute benefit of hypertension control, including more intensive control, on cardiovascular events is greater in adults ≥ 80 than 60-79 years old. The absolute rate of serious adverse events during antihypertensive therapy is greater in adults ≥ 80 years older than 60-79 years, yet the excess adverse event rate with intensive versus standard care is only moderately increased. Among adults ≥ 80 years, benefits of more intensive therapy appear non-existent to reversed with moderate to marked frailty and when cognitive function is less than roughly the twenty-fifth percentile. Accordingly, assessment of functional and cognitive status is important in setting blood pressure targets in older adults. Given substantial absolute cardiovascular benefits of more intensive antihypertensive therapy in independent-living older adults, this group merits shared-decision making for hypertension targets.
结果:女性的寿命比男性长,然而随着年龄的增长,收缩压和高血压患病率增加更多,高血压控制比男性下降更多,即,老年人的高血压是不成比例的女性健康问题。在健康到轻度虚弱的老年人中,高血压控制的绝对好处,包括更密集的控制,≥80岁的成年人的心血管事件发生率高于60~79岁.抗高血压治疗期间严重不良事件的绝对发生率在≥80岁的成年人中高于60-79岁,然而,强化治疗与标准治疗相比,过度不良事件发生率仅适度增加.在≥80岁的成年人中,更强化治疗的益处在中度至显著虚弱且认知功能小于约25百分位数的情况下似乎不存在逆转.因此,功能和认知状态的评估对于设定老年人的血压目标很重要.鉴于在独立生活的老年人中,更强化的抗高血压治疗对心血管的绝对益处,这一群体值得对高血压目标进行共同决策.