Blood pressure regulation is an automatic, moment-by-moment buffering of the blood pressure in response to physiological changes such as orthostasis, exercise and haemorrhage. This finely orchestrated reflex is called the baroreflex. It is a regulated arc of afferent, central and efferent arms. Multiple physiological changes occur with ageing that can disrupt this reflex, making blood pressure regulation less effective. In addition, multiple changes can occur with ageing-related diseases such as neurodegeneration, atherosclerosis, deconditioning and polypharmacy. These changes commonly result in orthostatic hypotension, hypertension or both, and are consistently associated with multiple adverse outcomes. In this article, we discuss the healthy baroreflex, and physiological and pathophysiological reasons for impaired baroreflex function in older people. We discuss why the common clinical manifestations of orthostatic hypotension and concomitant supine hypertension occur, and strategies for balancing these conflicting priorities. Finally, we discuss strategies for treating them, outlining our practice alongside consensus and expert guidance.

中文翻译：

---

衰老自主神经系统的新视野：体位性低血压和仰卧位高血压

血压调节是一种自动的、每时每刻的血压缓冲，以响应生理变化，如体位平衡、运动和出血。这种精心安排的反射称为压力反射。它是传入、中枢和传出臂的调节弧。随着年龄的增长会发生多种生理变化，这些变化会破坏这种反射，从而降低血压调节的效果。此外，神经变性、动脉粥样硬化、失调和多药治疗等与衰老相关的疾病会发生多种变化。这些变化通常会导致体位性低血压、高血压或两者兼而有之，并且始终与多种不良后果相关。在本文中，我们讨论健康的压力反射，老年人压力反射功能受损的生理和病理生理原因。我们讨论了为什么会出现直立性低血压和伴发的仰卧位高血压的常见临床表现，以及平衡这些相互冲突的优先事项的策略。最后，我们讨论治疗它们的策略，概述我们的实践以及共识和专家指导。