医患共同决策对老年高血压患者药物依从性影响的研究进展

Research Progress on the Impact of Shared Decision Making on Medication Compliance in Elderly Hypertensive Patients

摘要: 本文围绕老年高血压管理展开研究，梳理国内外进展并分析现存挑战。进展方面，全球老龄化推高老年高血压发病率(2015~2050年60岁及以上人口将翻倍至16亿)，其为心血管病主因，但管理受合并症、降压目标分歧等影响；高血压药物依从性差致控制不佳，受药物数量、性别、经济等多因素影响，固定剂量组合药物(FDC)及患者教育可改善；医患共同决策(SDM)能提升患者参与感与治疗效果，在高血压管理中具价值；药物依从性受患者社会支持、经济状况、药物特性及医疗系统支持四方面影响。挑战集中于三方面：老年患者因认知下降与合并症，对药物治疗认知不足；医患沟通存在语言、信任、费用沟通等问题，导致决策缺失；药物副作用显著降低患者依从性，影响治疗效果。

Abstract: This paper focuses on the management of hypertension in the elderly, reviewing domestic and international progress and analyzing existing challenges. In terms of progress, the global aging population has increased the incidence of hypertension among the elderly (the number of people aged 60 and above will double to 1.6 billion from 2015 to 2050), which is a major cause of cardiovascular diseases. However, management is affected by comorbidities and differences in blood pressure targets. Poor adherence to antihypertensive drugs leads to poor control, influenced by multiple factors such as the number of drugs, gender, and economic status. Fixed-dose combination drugs (FDC) and patient education can improve adherence. Shared decision making (SDM) can enhance patient participation and treatment outcomes, and is valuable in the management of hypertension. Adherence to drugs is influenced by four aspects: patient social support, economic status, drug characteristics, and medical system support. Challenges are concentrated in three areas: elderly patients have insufficient understanding of drug treatment due to cognitive decline and comorbidities; communication between doctors and patients has problems such as language, trust, and cost communication, leading to a lack of decision making; significant side effects of drugs reduce patient adherence and affect treatment outcomes.