老收缩期高血压的认识与治疗.ppt

（3）老年高血压降压注意事项 血压变异大，易波动。宜选长效药，并缓慢调整剂量； 个体化选药 重视防治低血压 (因老年心血管反射功能↓,交感神经抑制剂敏感，容量不足时抑制RAS血压敏感)； 注意体位性低血压(测坐位及立位血压) 起始降压药剂量宜小, 递增时间需更长； 不用影响认知能力的药物（利血平，可乐定等）。 单纯性收缩期高血压如舒张压降至65mmHg以下，应权衡在降低收缩压的同时，舒张压过度降低所带来的不利作用； 治疗首选长效钙拮抗剂，其次ACEI或利尿剂。β受体阻滞剂。 高龄老年高血压＞80岁建议用ACEI或利尿剂 (HYVET)。 (4)老年高血压联合用药 为有效地控制血压，干预并存危险因素和伴发症，保护靶器官，常需联合用药。 糖尿病/心衰：ACEI、ARB 、?阻断剂； 心绞痛： ?阻滞剂、长效CCB； 心肌梗塞： ACEI、?阻滞剂； * This slide demonstrates the changes related to aging. Based on the Framingham Heart Study, it is clear that as we age systolic blood pressure rises throughout. Diastolic blood pressure, on the other hand, rises in the population until about age 55 and then falls. This is not due to a “healthy survivor effect” but rather to anatomic changes in large arteries (increased collagen deposition) which leads to reduced vascular compliance and explains both of these measurements. * The recent National Health and Nutrition Survey (NHANES III), clearly showed that the majority of hypertensives in American have elevated SBP with the majority of those being at Stage 1 isolated systolic hypertension. This is not surprising in view of the aging population in the United States. * 国外的数据显示在65-89岁的患者中ISH所占比例为最高,在老年高血压患者占60%。而且，先前的幻灯图表显示该人群的比例是随着年龄增长而增长的。 * 。最新统计报道，老年人中ISH的患病率超过20%， 占所有老年高血压病人的一半以上，简单讲60岁以上高血压的老人中10个有6个是ISH的患者。如何有效，方便，安全的控制ISH,让老人健康地长寿是非常重要，中国的高血压治疗同样面对重要挑战。 * 在临床实践中，我们会发现患者随着年龄的增长，收缩压持续升高，而舒张压有降低的趋势。收缩压的升高呈线性，舒张压较平缓地升高，经过平台期，在70岁左右缓慢下降。 * Central Aortic Blood Pressure: the missing link The speed at which the outgoing and reflected waves travel is dependent on the stiffness of the arteries along which they are travelling. So if a person has stiffer arteries, the reflected waves ill travel back quicker, arriving earlier back at the heart. * Conlusion: Increasing arterial stiffness independently increases the central aortic blood pressure and thus the risk of all three major cardiovascular outcomes. * Elevated systolic BP correlates with an increase in the adjusted re