Blood pressure characteristics of elderly patients with hypertension Elderly hypertension is defined as those aged 65 years and older, with blood pressure persistent or more than 3 times non-same day sitting blood pressure ≥ 140 mmHg systolic and/or diastolic ≥ 90 mmHg. Geriatric hypertension has the following clinical features: 1. Increased systolic blood pressure is predominant and increased pulse pressure: 60% of geriatric hypertension. Systolic blood pressure increases with age in the elderly, while diastolic blood pressure decreases slowly after the age of 60, thus showing an increase in pulse pressure. Pulse pressure is an indicator of arterial elasticity, increased pulse pressure in the elderly is an important predictor of cardiovascular events, the greater the pulse pressure the greater the chance of cardiovascular events, and the corresponding increase in total mortality. 2, blood pressure fluctuations, prone to postural hypotension: With age, the arterial wall stiffness increases in elderly patients, compliance decreases, and the sensitivity of carotid pressure receptors decreases, that is, their ability to stabilize blood pressure decreases. As a result, blood pressure tends to fluctuate significantly with changes in mood and season, and there are more cases of “morning peak” blood pressure and postprandial hypotension. Postural hypotension is likely to occur with changes in body position, especially with diabetes, hypovolemia and the application of diuretics, vasodilators or psychotropic drugs. 3, common blood pressure circadian rhythm abnormalities: elderly patients with hypertension, non-arrythmic blood pressure (nighttime blood pressure compared to daytime blood pressure drop of less than 10%) incidence can be as high as 60% or more. 4, often coexist with a variety of diseases: elderly hypertension is often accompanied by arterial atherosclerosis, hyperlipidemia, diabetes, renal failure, dementia and other diseases, the incidence of coronary heart disease, stroke and other cardiovascular and cerebrovascular accidents and recurrence rate increased significantly. Four principles for the use of antihypertensive drugs in elderly hypertensive patients The application of antihypertensive therapy drugs should follow the following four principles, namely, starting with small doses, giving preference to long-acting agents, combined application and individualization. Since elderly patients with hypertension have their own characteristics, there are corresponding specifics in following the above principles: 1. Starting with small doses, antihypertensive should not be too low or too fast: On the one hand, drug metabolism in the elderly is relatively slow, which is due to the decline in renal blood flow with increasing age. The decrease in renal blood flow makes the kidney’s ability to clear drugs decrease. Giving the same dose of drugs to the elderly and young people, the elderly will have a lower clearance of drugs by the kidneys and a higher concentration of drugs in the blood, resulting in lowering blood pressure too low and too fast. On the other hand, the stiffness of the arterial wall increases in elderly patients, and the sensitivity to changes in blood pressure is subsequently reduced, making it very easy for postural hypotension to occur. For example, diuretics, due to the decreased ability of the elderly to retain sodium themselves, the amount of fluid in the body is relatively reduced, and after taking diuretics, the effective blood volume will be significantly reduced, which can lead to a decrease in blood supply to various organs in the body, making it easy to develop postural hypotension, resulting in insufficient blood supply to the brain leading to dizziness or even syncope. In addition, small doses help to observe drug reactions. For example, alpha-blockers may cause postural hypotension in elderly patients with hypertension, so treatment should be started with a small dose at bedtime and monitored to avoid postural hypotension. In the treatment effect needs to reduce the drug, should also start from a small dose gradually reduce the drug, if suddenly reduce the drug or even stop the drug is likely to cause blood pressure rebound, headache, dizziness and sympathetic excitement and other withdrawal syndrome, and even lead to hypertensive encephalopathy, the occurrence of stroke. 2, try to choose long-acting antihypertensive drugs: the elderly hypertension common circadian rhythm abnormalities and blood pressure “morning peak” phenomenon. Therefore, as far as possible to use a day once a day dose of long-acting drugs that have a continuous 24-hour antihypertensive effect, can effectively control the night blood pressure and morning peak blood pressure, more effective prevention of cardiovascular and cerebrovascular complications. If you use medium- or short-acting preparations, you need to take the drug 2-3 times a day, which is easy to miss, thus affecting the efficacy. 3, 2 or more kinds of drug combination: combination therapy can take advantage of the different kinds of antihypertensive drug mechanism, to achieve the efficacy of 1 + 1 > 2. Small dose combination therapy has better antihypertensive effect than high dose monotherapy, less adverse reactions, and is more conducive to target organ protection. It can also improve patient compliance and cost/benefit ratio. When the conventional dose of a single drug cannot lower the blood pressure to the target, multiple drug combination therapy should be used. Elderly hypertensive patients often need to take more than 2 antihypertensive drugs to achieve the blood pressure standard because the overall blood pressure level is higher than that of young and middle-aged patients. 4, individualized: elderly hypertension is often accompanied by a variety of diseases, therefore, according to the characteristics of the elderly individuals to choose different mechanisms of action of antihypertensive drugs. Generally speaking, systolic blood pressure is the main cause of hypertension in the elderly, so diuretics and calcium antagonists are more effective in lowering systolic blood pressure; b-blockers or long-acting calcium antagonists or angiotensin-converting enzyme inhibitors are preferred for combined coronary heart disease and stable angina; angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists are preferred for combined diabetes; angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists are preferred for combined chronic kidney disease. In combined chronic kidney disease, angiotensin II receptor antagonists and angiotensin II receptor antagonists are beneficial in preventing the progression of nephropathy, and in severe cases, a combination of diuretics may be required; for stroke prevention, angiotensin II receptor antagonists are preferred over b-blockers and calcium antagonists over diuretics; for improving left ventricular hypertrophy, angiotensin II receptor antagonists are preferred over b-blockers; for delaying carotid atherosclerosis, calcium antagonists are preferred over diuretics or b-blockers; for some elderly male patients with prostatic hypertrophy or other antihypertensive agents For some elderly male patients with prostate hypertrophy or patients whose blood pressure cannot be ideally controlled by other antihypertensive drugs, alpha-blockers can also be used for antihypertensive treatment. In conclusion, hypertension in the elderly is relatively difficult to control to the standard. Patients should tell their doctors in detail about their blood pressure characteristics, and doctors should keep trying different antihypertensive programs according to the above four principles to achieve a smooth blood pressure reduction. Like Auntie Wan, you should start by improving your sleep and soothing your emotions. It is advisable to ask a psychiatrist to assist in the treatment and take some anti-psychological drugs, which often have an unexpected effect. Clinical examples of success abound, so give it a try.