High blood pressure (hypertension) is an important risk factor for deaths of elderly people, and it must be taken seriously. Antihypertensive drugs should be taken in time for those to whom such drugs are necessary, whereas blood pressure being decreased to too low levels or too fast should be prevented at the same time. The definition of the target blood pressure must be based on the principle of individualization.
generally speaking, for the people over 60 years old, normal systolic blood pressure can be extended to 150 mmHg. Diastolic blood pressure is still 90 mmHg. Blood pressure goals is 150/90 mmHg. If the Elderly hypertensive patients with diabetes or chronic kidney disease, Blood pressure goals is 140/90 mmHg.
Blood pressure goals for elderly without diabetes or chronic kidney disease:
130/70 mmHg < blood pressure < 150/90 mmHg, Pulse pressur (SBP-DBP) < 70 mmHg
Treatment plan for elderly patients with hypertension
140 - 160, 90 - 99
Lifestyle interventions, Medication
Hypertension is a common and frequently-occurring disease of elderly people. In clinical practice, Elderly hypertension generally has the following characteristics:
Many cases are accompanied by serious complications
The elderly hypertensive patients are very sensitive to the antihypertensive agents
The pressure increment occurs mainly in systolic blood pressure and the pulse pressure difference becomes much bigger.
In addition, the blood pressure fluctuates easily and the orthostatic hypotension is apt to happen
These features increase the difficulty in treating Hypertension in elderly patients. Then what will matter for the patient in the treatment?
To adhere to individualized treatment
The symptoms of patients with hypertension vary widely, especially for the elderly patients with hypertension, because of the various physical strength, health condition, physiological function and the state of an illness, the response difference to the antihypertensive drugs is large as well. Therefore, the types and dose of drugs and compatibility of medicines should be paid attention to in the selection of antihypertensive drugs, the medicine cannot be blindly taken based on the past experience or the advertising or even the guidance friends and relatives, the medicine should be taken under the guidance of experienced doctors and according to the patient's specific conditions.
To strictly choose the drug
With the age increasing, the structure and function of the cardiovascular system of the elderly people tend to have degenerative changes. For the elderly people, heart rate becomes slower, cardiac output decreases, blood vessel wall thickens, all of these are prone to cause orthostatic hypotension (low blood pressure). Therefore, elderly hypertensive patients should choose the drugs with mild antihypertensive effect, small side effects and are unlikely to cause orthostatic hypotension (low blood pressure). The elderly people in general can choose calcium antagonists or converting enzyme inhibitor. To avoid depression, the elderly people should not use reserpine. At the same time, the poor memory and impaired liver function of the elderly people indicate that the long-acting antihypertensive drugs or sustained release medication should be given priority to, in order to facilitate patients to take medicine to control blood pressure.
Pay attention to the complications of hypertension
Hypertensive patients, especially the elderly patients with serious hypertension 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. See also: Drugs for complications of hypertension
Blood pressure should be reduced step by step
In clinical practice, the purpose of hypertension treatment is not only to reduce the blood pressure, but also more importantly to protect the functions of heart, brain, kidneys and other vital organs of patients, and improve survival rate and quality of life of patients. Therefore, the blood pressure of patients in the treatment of hypertension should be reduced step by step, a sudden drop in blood pressure should be avoided in order to stay away from serious complications such as acute myocardial infarction, renal failure, stroke.
To maintain a stable blood pressure
Patients should take medicine rationally based on the peak time of antihypertensive drugs’ action, the plasma half-life and the laws of their own blood pressure fluctuations in order to maintain a stable blood pressure. A larger blood pressure fluctuation can trigger stroke and acute myocardial infarction as well.
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
Drugs for complications of hypertension in the elderly
Will Exceedingly Decreased Blood Pressure Lead to Stroke?
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