高龄老年收缩期高血压患者临床特点及药物治疗随访分析

Clinical features of isolated systolic hypertension in very elderly patients and follow-up for drug treatment

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。

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 havingnbsp;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.