Blood Pressure Control in Elderly Patients with Hypertension

The elderly are the main incidence group of hypertension, and the reasonable selection of antihypertensive drugs is an effective measure to prevent and slow down the occurrence of cardiovascular and cerebrovascular complications in the elderly and improve their quality of life.

Geriatric hypertension is defined as age greater than 65 years old, with blood pressure values exceeding the standard diagnostic criteria for blood pressure, i.e., systolic blood pressure ≥ 140 mmHg (18.6 kPa) and/or diastolic blood pressure ≥ 90 mmHg (12 kPa) for more than three times on the same day.

Geriatric hypertension is mainly characterized by elevated systolic blood pressure, which is harmful to the heart and prone to heart failure; blood pressure fluctuates greatly, especially systolic blood pressure is prone to fluctuation; it also has many complications and unknown circadian rhythm, so clinical staff and patients should pay special attention to it.

Optional treatment drugs

Diuretics The treatment of senile hypertension based on low-dose diuretics, especially thiazide diuretics (such as hydrochlorothiazide), can prevent strokes and reduce the occurrence of cardiovascular disease, and their effects are mild and long-lasting, especially suitable for simple systolic hypertension.

Beta-blockers Although this class of drugs (e.g. propranolol) is less effective in elderly hypertension than in younger patients, it is still preferred for combined coronary angina, myocardial infarction, heart failure and even diabetes mellitus, especially for secondary prevention of myocardial infarction, which can prevent sudden death and reinfarction.

Calcium antagonists Compared with other drugs, calcium antagonists can better prevent stroke, do not affect the antihypertensive effect when high sodium intake, are suitable for patients with combined peripheral vascular disease, and have anti-atherosclerotic effects.

Angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists Angiotensin-converting enzyme inhibitors (e.g., captopril) are mainly used in patients with hypertension combined with diabetes mellitus, or complicated by cardiac insufficiency, myocardial infarction, or renal damage with proteinuria. Patients whose angiotensin-converting enzyme inhibitors cause dry cough can be switched to an angiotensin II receptor antagonist (e.g., colesartan).

Alpha receptor antagonists For elderly patients with hypertension combined with dyslipidemia and abnormal glucose tolerance, especially when combined with prostatic hyperplasia.

Precautions for medication use

(1) Take care of the dose, start with a small dose and gradually reach the target treatment amount.

The dose should be adjusted to the normal dose gradually after 2 weeks. Try to use 1 tablet/day or 1 time/day of antihypertensive drugs to improve the compliance of elderly patients, reduce blood pressure fluctuations, protect target organs and reduce the risk of cardiovascular events.

In the process of medication, do not stop or suddenly withdraw a certain drug, stop or change the drug must be a regular, slow, gradual process, so as not to lead to rebound, this rebound will not only present an increase in blood pressure values, but also accompanied by an increase in heart rate and the occurrence of angina pectoris, there will be some cardiovascular event hazards.

Medication needs to be adequate, but not excessive, and most elderly patients with hypertension need to take medication for a long time or even for life.

Dosing according to seasonal changes. In patients with mild to moderate hypertension, summer weather is hot, sweating, vasodilatation, and blood pressure drops. In winter, blood vessels contract and blood pressure rises.

Due to the influence of climate, the blood pressure value will change in different seasons, so the medication dose should be adjusted accordingly according to the seasonal changes.