Systolic Hypertension in Elderly patients is more dangerous to humans than other types of hypertensions, and it should arouse the high attention of People with high blood pressure.
The condition in which the systolic pressure and the diastolic pressure of elderly hypertensive patients aged over 65 are above 160 mmHg and below 90 mmHg, respectively is known as systolic hypertension in the elderly. More than 30% of patients manifest the above features in Europe and Americas. The genesis of systolic hypertension in the elderly may be associated with atherosclerosis, and it also can result in such complications as stroke and coronary heart disease.
Currently, there are difficulties to certain degrees in the treatment of Systolic Hypertension in Elderly in clinical practice because no drugs that decrease only systolic pressure but not diastolic pressure are available so far. Therefore, when patients are treated with conventional antihypertensive drugs, the diastolic pressure within the normal range is bound to be decreased, which may bring adverse effects to patients, especially to elderly patients with hypertension. Therefore, the systolic pressure of patients reduced to 150 mmHg will be okay, while the diastolic pressure should not be lower than 60 mmHg in any case. In the process of drug treatment, attention should be paid to changes in both the systolic pressure and the diastolic pressure, and the appropriate decrease in the systolic pressure while no exceedingly low diastolic pressure should be achieved as much as possible. Systolic Hypertension in Elderly Patients should actively have their relevant diseases treated, such as atherosclerosis, treated to narrow down the pulse pressure, thereby preventing complications.
Increased pulse pressure, namely the difference between the systolic pressure and the diastolic pressure exceeding 130 mmHg, compared to 40 to 60 mmHg in normal people.
Large pressure fluctuations: the fluctuation in the systolic pressure within 24 hours can reach over 50 mmHg. And sometimes, the fluctuation in the systolic pressure within 2 to 3 hours can reach 20 to 30 mmHg.
Concomitant orthostatic hypotension: namely the blood pressure of patients changes with that of their body positions, and their blood pressure when they are in the standing position is 30 to 50 mmHg lower than that when they are in the recumbent position.
Mastering the characteristics of changes in the blood pressure:
Patients should monitor their blood pressure to know the characteristics of changes in the blood pressure, which can serve as the basis for the selection of antihypertensive drugs and the determination of hypotensive standards. 24-hour Ambulatory Blood Pressure Measurement (ABPM) is recommended, it can help you to find out the characteristics of blood pressure changes.
Determining hypotensive standards
The diastolic pressure must be taken into considerations when the systolic pressure is decreased. The diastolic pressure of hypertensive patients with coronary artery disease should be kept between 60 to 80mmHg, or they are prone to myocardial infarction. The diastolic pressure of hypertensive patients with renal insufficiency should not be less than 90mmHg, or they may suffer from deterioration of renal function. The systolic pressure of hypertensive patients with cerebral arteriosclerosis should be maintained between 140 to 150mmHg. And, the blood pressure of elderly people aged over 80 years should be maintained at around 140/90 mmHg.
The following 2 points should be noted when patients with orthostatic hypotension are controlling their blood pressure:
The main focus is the adjustment of the diastolic pressure. In both the standing position and the recumbent position, their diastolic pressure should not be lower than 60mmHg. For example, the diastolic pressure of a patient in the standing position is 60mmHg and his systolic pressure is 160mmHg. If his systolic pressure is decreased to 150mmHg, his diastolic pressure is certainly lower than 60mmHg. Then, the only thing to do is to maintain his systolic pressure at 160 mmHg, because no drugs that decrease only systolic pressure but not diastolic pressure are available so far. In order to protect the heart and kidney function of patients from accidents, maintaining the normal minimum diastolic pressure is in them is more important than reducing the systolic pressure.
Patients’ medication should be adjusted according to the changes in their blood pressure in different positions.It’s also improper to enable the diastolic pressure not to be decreased to exceedingly lower levels while not to lower the systolic pressure actively. If the patient’s diastolic pressure is 60mmHg and his systolic pressure is not higher than 160mmHg in the standing position, it’s unnecessary to increase the dosage and continued observation of the blood pressure would be enough. If the patient’s systolic pressure surmounts the safe blood pressure of 180mmHg, short-acting antihypertensive drugs (such as nitrendipine, 5-10 mg each time) can be given with a frequent small dosage when the patients are in the recumbent position, followed by observation of the blood pressure. In that way, an appropriate dosage can be found. If the patient’s systolic pressure reach the normal standard of 140mmHg in the standing position, while is higher than 180mmHg in the recumbent position, the dosage of his antihypertensive drugs shouldn’t be increased at daytime, and only short-acting antihypertensive drugs can be given carefully at night. That is to say, not only the patient’s diastolic pressure has to be kept higher than the minimal pressure organs need for blood supply, but also his systolic pressure has to be kept near the normal level.
After the patient’s blood pressure stabilizes, the short-acting antihypertensive drugs can be replaced by long-acting ones so as to keep a stable blood pressure in them.
Be careful of changes in positions:
Systolic hypertension in elderly patients' blood pressure is likely to be higher with in the recumbent position and lower with in the standing position. Therefore, it is suggested that patients take a gentle move when getting out of bed to prevent fainting.
Be careful of patients' medication:
Systolic hypertension in elderly Patients are very sensitive to antihypertensive drugs, so it is recommended to start with small dose (generally half of the normal dose) when taking antihypertensive drugs.
Short-acting antihypertensive drugs (Nitrendipine, Captopril, ect.) should be chosen instead of long-acting ones (Amlodipine, Benazepril, ect.), which aren't appropriate for treatment.
Diuretic antihypertensive drugs (Hydrochlorothiazide, Spironolactone, ect.) aren’t appropriate for patients because the drugs tend to lower the blood volume and increase the pulse pressure.
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
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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