老年人高血壓的治療

Treatment of Hypertension in the Elderly

10.29461/TGG.200902.0001

謝明家(Ming-Chia Hsieh)；張毓泓(Yu-Hung Chang)；曾慶孝(Chin-Hsiao Tseng)

老年人 ； 高血壓 ； 抗高血壓藥物 ； 實證醫學 ； elderly ； hypertension ； anti-hypertensive agents ； evidence-based medicine

台灣老年醫學暨老年學雜誌

4卷1期（2009 / 02 / 01）

1 - 14

繁體中文

人口老年化已經成爲世界各國趨勢。根據世界衛生組織(WHO)的統計，目前全球60歲以上的人口有5億8千萬，預測2020年時會增加75%而達到10億之老年人口，其中以發展中國家的成長最爲快速。目前推估臺灣65歲以上的老年人約有230萬人，而這個數目己經佔了臺灣總人口的10%。因此在成爲高齡化社會的同時，老年人的照護也成爲一個重要的公共衛生課題。高血壓是老年人常見的慢性病之一，美國National Health and Nutrition Examination Survey (NHANES)的報告中發現67%超過60歲的老年人有高血壓的問題。目前在臺灣也約有65%的老年人有高血壓相關之疾病狀況，而且長久以來高血壓和其它高血壓相關疾病狀況也名列臺灣十大死因其中之四大項，而高血壓最後導致失能而需長期照護之情況更是令人怵目驚心。因此治療老年人高血壓對於臨床醫師恆爲一個非常重要的課題，本篇回顧了治療老年人高血壓的相關文獻與高血壓治療指引後，建議改變飲食及生活型態是治療老年人高血壓的第一步，如果未能達到控制目標即可根據病人的狀況選擇合適的高血壓藥物。血壓的控制目標可訂在＜140/90 mmHg，有糖尿病或腎臟病的老人可考慮將血壓控制目標更嚴謹地訂在＜130/80 mmHg；然而，80歲以上超高齡的老人是否也須將血壓作如此嚴格控制，可能需要更多的研究來證實。

Ageing of the global population has become one of the major challenges in the world. According to a report of World Health Organization, there are about 580 million people over 60 years old at present. By 2020, the number of aged people will reach one billion, the majority of them has been in developing countries. In Taiwan, there are around 2.3 million residents aged over 65 years, nearly 10% of total population. Therefore, eldercare has become an increasingly important public health issue as our aging society. Hypertension is one of the most common chronic conditions/diseaces in elderly people. According to the U.S. National Health and Nutrition Examination Survey (NHANES), 67% of the adults aged over 60 years were hypertensive, and the prevalence of hypertension in this counterpart age group around 65% in Taiwan. Moreover, hypertension and the associated conditions have been listed as 10 leading causes of mortality in Taiwan for long years. Based on these, treatment of hypertension in elderly people has become a major issue for clinician learning worldwidely. This article, after reviewing several large clinical studies and major treatment guidelines, has concluded that in the management of elderly hypertension, diet control and life style modification should be prioritized, and followed by anti-hypertensive medications. Thiazide can be an initial option without specific considerations. Treatment goal should be aimed at below 140/90 mmHg, but a lower level of 130/80 mmHg can be set for those with diabetes mellitus or chronic kidney disease. As for those extremely old (＞80 yrs), more clinical studies are necessary to help set up a proper treatment goal of blood pressure.

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