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老年人为什么要警惕收缩期高血压？用哪些降压药为好？

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2018-08-07

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收缩期高血压一般收缩压高于160mmHg，而舒张压低于95mmHg。由于年龄的增加，导致人体大动脉为主的动脉系统逐渐发生变化，为维持心、脑、肾等重要器官的液灌注，老年人收缩压常有升高倾向。

收缩期高血压治疗十分棘手,若降压过低会导致重要器官血液灌注不良,若任其持续升高,则心血管并发症可增加3～4倍,看来适度的降压是有意义的.一般认为收缩期血压超过180mmHg.随着全身动脉硬化的发展,患者心、脑、肾等各器官组织发生不同程度的缺血，且已有循环障碍，故降压治疗不宜过快，而应缓慢降压，以在2～3个月内缓慢降至160mmHg左右较为理想。提醒注意的是有部分收缩期高血压患者夜间血压极易下降，故这些患者不宜临睡前服用降压药。

收缩期血压的降压治疗，有关专家推荐可选用钙拮抗剂,ACEI或利尿降压药。钙拮抗剂如硝苯地平、尼群地平、尼莫地平等有良好的降压效应，且副作用少，对老年患者更易达到较高的血药浓度，能恢复受损的肾功能，可明显降低脑卒中的发生率。卡托普利等ACEI降压疗效确切，易耐受，能改善与四肢的供血，逆转或消退左心室肥厚。

此外，也可用钙拮抗剂与ACEI联用，对肥胖不伴糖尿病、肾病及无代谢性疾病的患者也可选用小剂量利尿药如氢氯噻嗪等。一般认为收缩期高血压发生脑卒中、冠心病、心力衰竭较舒张压升高危险性更大，与原发性高血压一样是诱发心肌梗死的重要危险因素。总之，随着老年收缩压的不断升高，心血管疾病患者的发病率与病死率不断上升，因此，收缩期高血压已引起临床高度注意。

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