Статья
Артериальная гипертония и антигипертензивная терапия у пациентов старших возрастных групп. Согласованное мнение экспертов Российской ассоциации геронтологов и гериатров, Антигипертензивной Лиги, Национального общества профилактической кардиологии.
Повышенное артериальное давление (АД) является фактором риска сердечно-сосудистой заболеваемости и смертности, а также снижения когнитивных функций и утраты автономности в более позднем периоде жизни. Рандомизированные клинические исследования (РКИ) в популяциях пациентов старшего возраста, проживающих дома, с невысокой коморбидностью и сохранной автономностью указывают на пользу снижения повышенного АД у пациентов старше 80 лет. Пациенты старшего возраста со старческой астенией, с утратой автономности и рядом других гериатрических проблем систематически исключались из РКИ, а наблюдательные исследования у этих групп пациентов указывают на повышение заболеваемости и смертности при более низком уровне АД и на фоне антигипертензивной терапии. Очевидно, что у очень пожилых пациентов не может применяться универсальная стратегия лечения артериальной гипертонии (АГ) в виду значительной гетерогенности их функционального статуса. Гериатрический подход к ведению АГ у пациентов старшего возраста предполагает оценку функционального статуса, наличия старческой астении и степени сохранности автономности для выбора тактики антигипертензивной терапии.
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