陈鲁原老年高血压特点与药物选择.ppt

这是2002年全国营养调查研究，数据显示老年人群中得到治疗的少于1/3，而治疗后得到控制的仅有1/4. 总的达标率仅仅是7.6% 。因此老年人的血压管理现状不容乐观。 低治疗率和低控制率令人担忧，提高老年高血压的治疗水平刻不容缓 * 有部分患者表现为血浆RAAS正常，局部RAAS系统激活 强调水钠潴留的影响 * * Slide 69 Characteristics of hypertension in the elderly Many age-related physiologic and cardiovascular changes contribute to elevated BP in the elderly. Cardiovascular adaptations to high BP were studied in 60 patients with established essential hypertension (30 patients aged 65 years and older and 30 patients aged less than 42 years). (Messerli, et al. 1983.) Cardiac output, heart rate, stroke volume, intravascular volume, renal blood flow, and plasma renin activity were significantly lower in the elderly. Total peripheral (and renal vascular) resistance, left ventricular posterior wall and septal thicknesses, and left ventricular mass were higher. The aging process causes vascular changes that appear to be crucial factors leading to the development of ISH. (Izzo, et al. 2000.) Age-related changes in BP result from the generalized process of increasing arterial stiffness caused by the progressive replacement of elastin by collagen in the walls of large arteries. (Izzo, et al. 2000.) SBP increases in older patients as a result of arterial stiffness and functional changes caused by aging, while DBP decreases or remains the same, and the PP widens. References Messerli FH, Sundgaard-Riise K, Ventura HO, Dunn FG, Glade LB, Frohlich ED. Essential hypertension in the elderly: hemodynamics, intravascular volume, plasma renin activity, and circulating catecholamine levels. Lancet. 1983;2:983-986. Izzo JL, Jr., Levy D, African American HR. Clinical Advisory Statement. Importance of systolic blood pressure in older Americans. Hypertens. 2000;35:1021-1024. Weidmann P, De Myttenaere, et al. Effect on aging on plasma renin and aldosterone in normal man. Kidney Int. 1975;8(5):325-333. * * 但如果我们应用基于血清肌酐、年龄、性别、体重的评估公式来测算GFR水平时，令人惊讶地发现，随着年龄的增加，到40岁以后，GFR几乎是呈线性下降的。换而言之，临床上经常作为肾功能评价指标的血清肌酐即使处于正常水平，但老年人可能已经出现GFR下降。 iso