中华老年多器官疾病杂志
中華老年多器官疾病雜誌
중화노년다기관질병잡지
CHINESE JOURNAL OF MULTIPLE ORGAN DISEASES IN THE ELDERLY
2015年
8期
587-592
,共6页
佟翠艳%何瑞%李春辉%孟威宏%田志远
佟翠豔%何瑞%李春輝%孟威宏%田誌遠
동취염%하서%리춘휘%맹위굉%전지원
老年人,80以上%收缩期高血压%钙通道阻滞药%降压药物治疗
老年人,80以上%收縮期高血壓%鈣通道阻滯藥%降壓藥物治療
노년인,80이상%수축기고혈압%개통도조체약%강압약물치료
aged,80 and over%systolic hypertension%calcium channel blockers%antihypertensive drug therapy
目的：分析调查高龄老年患者单纯收缩期高血压（ISH）的临床特点及药物治疗情况。方法收集2008年1月至2009年10月于沈阳军区总医院住院的ISH老年患者（≥80岁）403例，随访5年，分析其基线情况、用药前后血压及心血管并发症情况，统计各类降压药物包括钙通道阻滞剂（CCB）、血管紧张素转换酶抑制剂（ACEI）、血管紧张素受体拮抗剂（ARB）、β?受体阻滞剂、利尿剂、α?受体阻滞剂、硝酸酯类等药物的应用情况。结果403例患者中Ⅰ级高血压83例（20.6%），Ⅱ级高血压216例（53.6%），Ⅲ级高血压104例（25.8%）；治疗前有合并症者375例（93.1%），随访5年后有合并症者397例（98.5%）；收缩压＞150mmHg者及舒张压＜60mmHg者并发症的发生率最高；从年龄分组及血压分组来看各组血压均控制较好，治疗12周338例患者血压达标（83.9%），随访至5年时共有340例患者血压控制达标（84.4%），从年龄分组及按血压分组来看，用药12周后及随访5年后血压与用药前比较差异均具有统计学意义（收缩压P＜0.01，舒张压P＜0.05）；随访5年后收缩压＜140mmHg者135例，舒张压＜60mmHg者55例；从降压药物的应用来看，CCB应用者最多182例，其余依次为β?受体阻滞剂179例，利尿剂167例，硝酸酯类132例，ACEI及ARB各112例，α?受体阻滞剂应用最少为5例。单独应用1种降压药物者74例（18.4%）较少，多为联合用药（329例，81.6%），应用4种降压药物者53例（13.2%）最少，应用2种降压药物者180例（44.7%）最多。结论高龄老年ISH患者并发心血管病的患病率较高，降压治疗上选择药物要根据患者的临床情况，血压及有无并发症进行个体化治疗，多需要联合用药。在治疗老年人ISH时不仅要收缩压达标，还要注意舒张压情况，舒张压＜60mmHg时可能增加患者心血管并发症的发生。
目的：分析調查高齡老年患者單純收縮期高血壓（ISH）的臨床特點及藥物治療情況。方法收集2008年1月至2009年10月于瀋暘軍區總醫院住院的ISH老年患者（≥80歲）403例，隨訪5年，分析其基線情況、用藥前後血壓及心血管併髮癥情況，統計各類降壓藥物包括鈣通道阻滯劑（CCB）、血管緊張素轉換酶抑製劑（ACEI）、血管緊張素受體拮抗劑（ARB）、β?受體阻滯劑、利尿劑、α?受體阻滯劑、硝痠酯類等藥物的應用情況。結果403例患者中Ⅰ級高血壓83例（20.6%），Ⅱ級高血壓216例（53.6%），Ⅲ級高血壓104例（25.8%）；治療前有閤併癥者375例（93.1%），隨訪5年後有閤併癥者397例（98.5%）；收縮壓＞150mmHg者及舒張壓＜60mmHg者併髮癥的髮生率最高；從年齡分組及血壓分組來看各組血壓均控製較好，治療12週338例患者血壓達標（83.9%），隨訪至5年時共有340例患者血壓控製達標（84.4%），從年齡分組及按血壓分組來看，用藥12週後及隨訪5年後血壓與用藥前比較差異均具有統計學意義（收縮壓P＜0.01，舒張壓P＜0.05）；隨訪5年後收縮壓＜140mmHg者135例，舒張壓＜60mmHg者55例；從降壓藥物的應用來看，CCB應用者最多182例，其餘依次為β?受體阻滯劑179例，利尿劑167例，硝痠酯類132例，ACEI及ARB各112例，α?受體阻滯劑應用最少為5例。單獨應用1種降壓藥物者74例（18.4%）較少，多為聯閤用藥（329例，81.6%），應用4種降壓藥物者53例（13.2%）最少，應用2種降壓藥物者180例（44.7%）最多。結論高齡老年ISH患者併髮心血管病的患病率較高，降壓治療上選擇藥物要根據患者的臨床情況，血壓及有無併髮癥進行箇體化治療，多需要聯閤用藥。在治療老年人ISH時不僅要收縮壓達標，還要註意舒張壓情況，舒張壓＜60mmHg時可能增加患者心血管併髮癥的髮生。
목적：분석조사고령노년환자단순수축기고혈압（ISH）적림상특점급약물치료정황。방법수집2008년1월지2009년10월우침양군구총의원주원적ISH노년환자（≥80세）403례，수방5년，분석기기선정황、용약전후혈압급심혈관병발증정황，통계각류강압약물포괄개통도조체제（CCB）、혈관긴장소전환매억제제（ACEI）、혈관긴장소수체길항제（ARB）、β?수체조체제、이뇨제、α?수체조체제、초산지류등약물적응용정황。결과403례환자중Ⅰ급고혈압83례（20.6%），Ⅱ급고혈압216례（53.6%），Ⅲ급고혈압104례（25.8%）；치료전유합병증자375례（93.1%），수방5년후유합병증자397례（98.5%）；수축압＞150mmHg자급서장압＜60mmHg자병발증적발생솔최고；종년령분조급혈압분조래간각조혈압균공제교호，치료12주338례환자혈압체표（83.9%），수방지5년시공유340례환자혈압공제체표（84.4%），종년령분조급안혈압분조래간，용약12주후급수방5년후혈압여용약전비교차이균구유통계학의의（수축압P＜0.01，서장압P＜0.05）；수방5년후수축압＜140mmHg자135례，서장압＜60mmHg자55례；종강압약물적응용래간，CCB응용자최다182례，기여의차위β?수체조체제179례，이뇨제167례，초산지류132례，ACEI급ARB각112례，α?수체조체제응용최소위5례。단독응용1충강압약물자74례（18.4%）교소，다위연합용약（329례，81.6%），응용4충강압약물자53례（13.2%）최소，응용2충강압약물자180례（44.7%）최다。결론고령노년ISH환자병발심혈관병적환병솔교고，강압치료상선택약물요근거환자적림상정황，혈압급유무병발증진행개체화치료，다수요연합용약。재치료노년인ISH시불부요수축압체표，환요주의서장압정황，서장압＜60mmHg시가능증가환자심혈관병발증적발생。
ObjectiveTo investigate the clinical features of isolated systolic hypertension (ISH) in very elderly patients and their condition after drug therapy.Methods Clinical data of 403 very elderly hospitalized patients (≥ 80 years old) suffering from ISH in our hospital from January 2008 to October 2009 were collected. All of them were followed up for duration of 5 years. Their basic data, incidences of hypertensive and cardiovascular complications, the usage of antihypertensive drugs, including calcium channel blocker (CCB), angiotensin-converting enzyme inhibitor (ACEI), angiotensinⅡ-receptors antagonist (ARB),β-receptor blocker, diuretics,α-receptor blocker, and nitrates were analyzed.Results Among the 403 patients, 83 patients (20.6%) were grade Ⅰ hypertension, 216 (53.5%) gradeⅡ hypertension, and 104 (25.8%) grade Ⅲ hypertension. There were 375 cases (93.1%) having complications before treatment, and 397 cases (98.5%) after 5 years’ treatment. The patients with systolic blood pressure (SBP) above 150mmHg and diastolic blood pressure (DBP) below 60mmHg had the highest incidences of complications. No matter the patients were divided according to their age or blood pressure, the blood pressure was well-controlled. The rate of well-controlled blood pressure was 83.9% after 12 weeks’ treatment, and 84.4% in 5 years later, both with significant difference when compared with the pressure before treatment (SBP,P<0.01; DBP,P<0.05). There were 135 cases having SBP below 140mmHg, and 55 cases having DBP below 60mmHg. CCB was most commonly used antihypertensive drug (n=182), followed byβ-receptor blocker (n=179), diuretics (n=167), nitrates (n=132), ACEI (n=112), ARB (n=112), andα-receptor blocker (n=5) sequentially. Most of the patients used more than 1 kind of antihypertensive drugs (329, 81.6%). Among them, those took combination of 4 kinds were the least (53, 13.2%), and those administered combination of 2 kinds was the most (180, 44.7%). Only 74 patients (18.4%) used only 1 kind of antihypertensive drug.Conclusion It is quite common for the very elderly ISH patients to have complications. In clinical practice, antihypertensive drug should be selected according to the patient’s condition, and individualized therapy needs to be designed based on blood pressure and comorbidities. Most of the patients need combination of different drugs. During the treatment, clinician should control not only SBP, but also DBP. DBP below 60mmHg might increase the incidence of cardiovascular complications.
