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Сообщение от DrMaya
подскажите по поводу старших возрастных групп
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The ACC/AHA writing committee recommends treatment with a single drug
for patients >80 years of age, followed by a second drug if needed, in order to achieve a systolic blood pressure of
140 to 145 mm Hg. The writing committee states that low-dose thiazides, calcium antagonists, and renin-angiotensin-aldosterone system (RAAS) blockers are preferred, but the use of concomitant medications will likely dictate drug therapy. For individuals aged
65 to 79 years old, the committee recommends a treatment target of less
than 140/90 mm Hg.
связано это с тем, что в самом крупном трайле HYVET, который показал, что антигипертензивная терапия благоприятствует у пожилых за 80, целевые цифры САД были менее 150 (у половины цифры достигли 140-145):
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предыдущие наблюдения за пожилыми показали, что САД менее 140 ассоциируется с худшим прогнозом:
SBP was the strongest predictor. In Cox regression analyses, low SBP (<or=120 mmHg) correlated with greater 4-year all-cause mortality alone and when controlling for health status. This connection persisted after exclusion of deaths within the first year. There was a tendency toward a U-shaped mortality curve for the adjusted model, with SBP of 164.2 mmHg (95% confidence interval=154.1-183.8 mmHg) being associated with the lowest mortality.
J Am Geriatr Soc. 2008 Oct;56(10):1853-9. Epub 2008 Sep 22.
Lower systolic blood pressure is associated with greater mortality in people aged 85 and older.
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J Am Geriatr Soc. 2007 Mar;55(3):383-8.
Blood pressure and survival in the oldest old.
Subjects with higher BP (up to a systolic BP (SBP) of 139 mmHg and a diastolic BP (DBP) of 89 mmHg) were less likely to die during follow-up than subjects with lower BP. After baseline adjustments, the hazard ratio for a 10-point increase in SBP was 0.82 (95% confidence interval (CI)=0.74-0.91), up to a SBP of 139 mmHg, and for DBP was 0.85 (95% CI=0.78-0.92), up to a DBP of 89 mmHg. There was no significant association between survival and BP levels in subjects with uncontrolled hypertension.