Hypertensive patients, especially the elderly patients with serious hypertension (high blood pressure) are often associated with diabetes, hyperlipidemia, and a variety of heart, brain and kidney complications. Patients with these complications should be more careful in the drug selection.
For these patients, should use the drugs which can prevent or reverse the left ventricular hypertrophy. Such as calcium antagonists (nifedipine, nitrendipine) , beta-blockers (metoprolol, atenolol, bisoprolol, propranlolum), ACE inhibitors(captopril, enalapril), Since vasodilators (hydralazine) can aggravate the ventricular hypertrophy, so the hypertensive patients with left ventricular hypertrophy should not take it.
Because Propranolol can reduce blood pressure, slow down the heart rate, reduce myocardial oxygen consumption, so the hypertensive patients with angina pectoris should choose beta-blockers first. In addition, the calcium antagonist can both reduce the blood pressure and improve myocardial ischemia, and has a good therapeutic effect on the patients. However, the vasodilators can increase the heart rate, it should be used with propranolol and other drugs in combination.
For the hypertensive patients with renal insufficiency, the drugs used should not have an effect on the renal blood flow or should increase the renal blood flow, such as methyldopa, minoxidil and so on. The loop diuretics (such as dihydrochlorothiazide, etc.) should be selected when selecting the diuretics, potassium-sparing diuretics (such as triamterene, etc.) should be avoided. Because guanethidine and clonidine can reduce the blood pressure and the renal blood flow at the same time, so it is not suitable for the hypertensive patients accompanied by renal insufficiency. Patients with renal artery stenosis, severe renal insufficiency, solitary kidney should avoid ACE inhibitors (angiotensin converting enzyme inhibitor).
For hypertensive patients with stroke, the calcium antagonists and ACE inhibitors may improve the condition of cerebral ischemia, so these drugs can be used. And Beta-blockers can aggravate cerebral ischemia, so patients should not use it.
For the hypertensive patients with diabetes, because ACE inhibitors can promote the development of kidney disease, and beta-blockers can hide the insulin shock symptoms, so it is best not to use these two drugs.
For the hypertensive patients with hyperlipidemia, because the calcium antagonists and ACE inhibitors have no effect on lipid metabolism, and alpha blocker is favorable for the lipid metabolism, so these types of drugs can be used.
Blood pressure goals for elderly
The greater the pulse pressure is, the more risks there will be
Narrow the pulse pressure without non antihypertensive drug
Systolic hypertension in elderly (SBP > 160 mmHg, DBP < 90 mmHg)
Decreased systolic pressure can better indicate the actual effects of blood pressure control
Will Exceedingly Decreased Blood Pressure Lead to Stroke?
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