PDF(Pubmed)
Abstract：
The population of older adults 60-79 years globally is projected to double from 800 million to 1.6 billion between 2015 and 2050, while adults ≥ 80 years were forecast to more than triple from 125 to 430 million. The risk for cardiovascular events doubles with each decade of aging and each 20 mmHg increase of systolic blood pressure. Thus, successful management of hypertension in older adults is critical in mitigating the projected global health and economic burden of cardiovascular disease.
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.
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.
摘要：
目标：从2015年到2050年，全球60-79岁的老年人口预计将翻一番，从8亿增加到16亿，而≥80岁的成年人预计将从1.25亿增加到4.3亿，增加两倍以上。随着年龄的增长和收缩压每增加20mmHg，心血管事件的风险就会增加一倍。因此，成功管理老年人高血压对于减轻预期的全球心血管疾病的健康和经济负担至关重要.
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.
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.
