高龄衰弱高血压患者，起始降压阈值及控制目标值如何把握？

参考文献

[1] 张梅, 吴静, 张笑, 等 . 2018年中国成年居民高血压患病与控制状况研究[J]. 中华流行病学杂志， 2021， 42（10）： 1780-1789.

[2] 马守原, 王曙霞, 朱平 . 高龄老年人血压的高质量管理探讨[J]. 中华高血压杂志 (中英文)， 2025， 33（7）： 607-613.

[3] 中国老年医学学会高血压分会, 北京高血压防治协会, 北京高血压防治协会, 等 . 中国老年人高血压管理指南2023[J]. 中华高血压杂志， 2023， 31（6）： 508-538.

[4] 中国高血压防治指南修订委员会, 高血压联盟 (中国), 中国医疗保健国际交流促进会高血压病学分会, 等 . 中国高血压防治指南(2024年修订版)[J]. 中华高血压杂志 (中英文)， 2024， 32（7）： 603-700.

[5] 中华医学会老年医学分会 . 老年患者衰弱评估与干预中国专家共识[J]. 中华老年医学杂志， 2017， 36（3）： 251-256.

[6] 中华医学会心血管病分会老年学组, 国家老年疾病临床研究中心[解放军总医院] . 老年心血管疾病合并衰弱评估和与管理中国专家共识2023[J]. 中华老年多器官疾病杂志， 2023， 22（7）： 481-491.

[7] McEvoy JW, McCarthy CP, Bruno RM, et al. ESC Scientific Document Group. 2024 ESC guidelines for the management of elevated blood pressure and hypertension[J]. Eur Heart J, 2024, 45(38): 3912-4018.

[8] 国家心血管病中心国家基本公共卫生服务项目基层高血压管理办公室, 国家基层高血压管理专家委员会 . 国家基层高血压防治管理指南2025版[J]. 中华心血管病杂志， 2025， 53（9）： 977-991.

[9] Goupil R, Tsuyuki RT, Santesso N, et al. Hypertension Canada guideline for the diagnosis and treatment of hypertension in adults in primary care[J]. CMAJ， 2025， 197（20）： E549-E564.

[10] Jones DW, Ferdinand KC, Taler SJ, et al. 2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM guideline for the prevention, detection, evaluation and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines[J]. Hypertension， 2025， 82（10）： e212-e316.

[11] Li S, Peng Y, Li Y, et al. Effects of intensive blood pressure control in patients with frailty: a post hoc analysis from ESPRIT[J]. J Am Coll Cardiol， 2026， 87（1）： 4-16.

[12] 李建华, 范利, 赵婷, 等 . 老年高血压患者发生衰弱对预后的影响[J]. 中华老年多器官疾病杂志， 2018， 17（5）： 324-328.

[13] Ravindrarajah R, Hazra NC, Hamada S, et al. Systolic blood pressure trajectory, frailty, and all—cause mortality ＞80 years of age: cohort study using electronic health records[J]. Circulation， 2017， 135（24）： 2357-2368.

[14] Muller M, Smulders YM, de Leeuw PW, et al. Treatment of hypertension in the oldest old: a critical role for frailty?[J]. Hypertension， 2014， 63（3）： 433-441.

[15] The Lancet . Population ageing in China: crisis or opportunity?[J]. Lancet， 2022， 400（10366）： 1821.

[16] 国家统计局 . 人口高质量发展持续推进[EB/OL]. (2026—01—19)[ 2026—03—01]. https://www.stats.gov.cn/sj/sjjd/202601/t20260119_1962338.html.

[17] Gao J, Zhang X, Wei C . A study on gender—based differences in frailty in the oldest—old[J]. Chin J Geriatr， 2020， 39（11）： 1335-1339.

[18] Howlett SE, Rutenberg AD, Rockwood K . The degree of frailty as a translational measure of health in aging[J]. Nat Aging， 2021， 1： 651-665.

[19] Fried LP, Cohen AA, Xue QL, et al. The physical frailty syndrome as a transition from homeostatic symphony to cacophony[J]. Nat Aging， 2021， 1（1）： 36-46.

[20] Hoogendijk EO, Afilalo J, Ensrud KE, et al. Frailty: implications for clinical practice and public health[J]. Lancet， 2019， 394（10206）： 1365-1375.

[21] Veronese N, Custodero C, Cella A, et al. Prevalence of multidimensional frailty and pre—frailty in older people in different settings: a systematic review and meta—analysis[J]. Ageing Res Rev， 2021， 72： 101498.

[22] Todd OM, Wilkinson C, Hale M, et al. Is the association between blood pressure and mortality in older adults different with frailty? A systematic review and meta—analysis[J]. Age Ageing， 2019， 48（5）： 627-635.

[23] Rockwood MR, Howlett SE . Blood pressure in relation to age and frailty[J]. Can Geriatr J， 2011， 14（1）： 2-7.

[24] 惠嫣然, 黄丽君, 郑新璐, 等 . 老年高血压患者合并衰弱时的血压特征[J]. 中华高血压杂志 (中英文)， 2025， 33（7）： 620-624.

[25] Mogi M . Pulse pressure tells the story of sarcopenia[J]. Hypertens Res， 2024， 47（9）： 2583-2585.

[26] Gu Y, Wan Y, Ren JH, et al. Analysis of systolic and diastolic blood pressure variability in frail, pre—frail, and non—frail elderly patients: the relationship between frailty syndrome and blood pressure variability in the elderly[J]. Medicine (Baltimore)， 2023， 102（8）： e32874.

[27] Shen F, Chen J, Yang R, et al. Association between control status of blood pressure and frailty among middle—aged and older adults with hypertension in China: a longitudinal study[J]. BMJ Open， 2022， 12（3）： e056395.

[28] Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH guidelines for the management of arterial hypertension[J]. Eur Heart J， 2018， 39（33）： 3021-3104.

[29] Unger T, Borghi C, Charchar F, et al. 2020 International Society of Hypertension global hypertension practice guidelines[J]. Hypertension， 2020， 75（6）： 1334-1357.

[30] National Institute for Health and Care Excellence. Hypertension in adults: diagnosis and management [DB/OL]. (2022—03—18)[ 2022—04—28]. https://www.nice.org.uk/guidance/ng136/chapter/recommendations#monitoring—treatment—and—blood—pressure—targets.

[31] Beckett NS, Peters R, Fletcher AE, et al. Treatment of hypertension in patients 80 years of age or older[J]. N Engl J Med， 2008， 358（18）： 1887-1898.

[32] Kjeldsen SE, Lund—Johansen P, Nilsson PM, et al. Unattended blood pressure measurements in the systolic blood pressure intervention trial: implications for entry and achieved blood pressure values compared with other trials[J]. Hypertension， 2016， 67（5）： 808-812.

[33] Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH guidelines for the management of arterial hypertension. The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH)[J]. J Hypertens, 2018, 36(10): 1953-2041.

[34] Zhang W, Zhang S, Deng Y, et al. Trial of intensive blood—pressure control in older patients with hypertension[J]. N Engl J Med， 2021， 385（14）： 1268-1279.

[35] SPRINT Research Group, Lewis CE, Fine LJ, et al. Final report of a trial of intensive versus standard blood—pressure control[J]. N Engl J Med， 2021， 384（20）： 1921-1930.

[36] Warwick J, Falaschetti E, Rockwood K, et al. No evidence that frailty modifies the positive impact of antihypertensive treatment in very elderly people: an investigation of the impact of frailty upon treatment effect in the hypertension in the very elderly trial (HYVET) study, a double—blind, placebo—controlled study of antihypertensives in people with hypertension aged 80 and over[J]. BMC Med， 2015， 13： 78.

[37] Supiano MA, Ascher SB, Rich MW . Hypertension in the oldest old[J]. JACC Adv, 2025, 4(12 Pt 1): 102306.

[38] Ohya Y, Arakawa K, Arata N, et al. The Japanese Society of Hypertension guidelines for the management of elevated blood pressure and hypertension 2025 (JSH2025)[J]. Hypertens Res， 2026， 49： 9-235.

[39] Mancia G, Kreutz R, Brunstrom M, et al. 2023 ESH guidelines for the management of arterial hypertension the task force for the management of arterial hypertension of the European Society of Hypertension: Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA)[J]. J Hypertens， 2023， 41(12)： 1874-2071.

[40] Yamamoto K . JSH2025 guidelines for hypertension management in older adults: international comparison[J]. Hypertens Res， 2026， 49(4)： 1537-1540.

[41] Kim DH, Rockwood K . Frailty in older adults[J]. N Engl J Med， 2024， 391（6）： 538-548.

[42] Benetos A, Gautier S, Freminet A, et al. Reduction of antihypertensive treatment in nursing home residents[J]. N Engl J Med， 2025， 393（20）： 1990-2000.

[43] Lyu Y, Bian W, Liu Y, et al. Frailty index offers greater discrimination than age for optimal blood pressure targets: a pooled analysis of two randomized trials[J]. Hypertension， 2026， 83： e26397.

[44] Verdecchia P, Angeli F, Reboldi G . The lowest well tolerated blood pressure: a personalized target for all?[J]. Eur J Intern Med， 2024， 123： 42-48.

[45] Rivasi G, Brunetti E, Presta R, et al. Elevated blood pressure and hypertension in older persons: a comment on the recent ESC guidelines[J]. Eur J Intern Med， 2024， 130： 44-50.