老年高血压的处理总结.ppt

* I will review these five major characteristics, beginning with one of the pathognomic features - decreased vascular compliance or vascular stiffness. One manifestation of vascular stiffness is a change in pulse contour. Older people are more likely to have predominately systolic hypertension. Several studies have indicated that the pulse pressure is a significant independent cardiac risk factor. One of the challenges in defining sodium sensitivity of blood pressure is that it requires access to a metabolic kitchen and dedicated subjects. Fortunately for us, the GCRC offers these resources. This is the protocol we used to determine sodium sensitivity of blood pressure in a group of 24 older hypertensive subjects. Constant diet identical in composition except for Na+ content. Given in random order. High = 208, Low is very low, 20. MABP measured at the conclusion of the two diet periods. Increase in prevalence of obesity (BMI 30) up to age 75. Women men. BUT, It’s not just more body fat, but its distribution that changes with age. Central obesity also becomes more prevalent. First, insulin resistance… Many studies have demonstrated an association between insulin resistance and hypertension. We conducted a study in 60 older normotensive and hypertensive subjects to address this question. Network meta-analysis of 42 RCT, 200K pts Rx with 7 treatments including placebo. Low dose diuretics identified as most effective first line therapy. In summary…. Total Mortality (21% reduction) P=0.019 Fatal Stroke (39% reduction) P=0.046 Heart Failure (64% reduction) P0.0001 我的看法 可适当治疗，但不必强求 缓慢达标 生活方式 综合治疗（CHD） 女性，71岁，血压170/60 mmHg 是否降压治疗？ 舒张压低到什么地步不能降压？即生存曲线有无 J 点 Evidence for a J-Curve 1979 Stewart 报道舒张压低于 90 mm Hg，心肌梗死的风险增加5倍 1987 Farnett et al., 1991; Samuelsson et al., 1990).舒张压从100-85危险降低，85－80，危险增加 Kannel et al. 舒张压低于 80mmHg 危险增高者仅发生于收缩压大于140 mm Hg者. Somes et al., 1999; Vokó et al., 1999 单纯ISH，中风增加见于舒张压低于65 mm Hg Messerli et al., 2005. INVEST trial of 22,000 冠心病患