Age ≥60 years and blood pressure persistent or more than 3 times non-same day sitting systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90rnmHg is called geriatric hypertension, if systolic blood pressure ≥140
mmHg and diastolic blood pressure <90 mmHg, then it is called simple systolic hypertension. Elderly patients with hypertension have their own characteristics. 1. Systolic blood pressure increases mainly Systolic blood pressure increases with increasing age in the elderly, and diastolic blood pressure tends to decrease after the age of 60. Compared with diastolic blood pressure, systolic blood pressure is more closely related to target organ damage such as heart, brain and kidney, and is a more important independent predictor of cardiovascular and cerebrovascular events. 2. Increased pulse pressure Pulse pressure is an indicator of arterial elasticity function and is associated with physiological aging and a variety of diseases that cause vascular aging. Increased pulse pressure is a characteristic of hypertension in the elderly and is defined as a pulse pressure >40 mmHg, which can be 50-100 mmHg in the elderly.
Several studies have shown that pulse pressure in the elderly is positively associated with all-cause mortality, cardiovascular mortality, stroke, and the development of coronary artery disease. Other studies have shown that pulse pressure in elderly patients is not a better predictor of cardiovascular events than systolic blood pressure. 3. High blood pressure fluctuations With age, blood pressure in elderly patients with hypertension tends to fluctuate significantly with changes in mood, season and body position, and early morning hypertension is common. The fluctuation of blood pressure in the elderly increases the difficulty of antihypertensive treatment and requires careful selection of antihypertensive drugs. In addition, elderly patients with hypertension often have coronary artery, renal artery, carotid artery and intracranial artery lesions, etc. When blood pressure fluctuates sharply, cardiovascular and cerebrovascular events and target organ damage can increase significantly. 4. postural hypotension Postural hypotension refers to a decrease in systolic blood pressure of ≥20 mmHg or diastolic blood pressure of ≥10 mmHg within 3 min of changing from a recumbent to an upright position (or an upright tilt test of at least 60°), accompanied by dizziness or syncope and other symptoms of inadequate cerebral circulation perfusion. Elderly patients are prone to postural hypotension due to vascular sclerosis, reduced arterial compliance, and decreased autonomic nervous system regulation. Postural hypotension is more likely to occur when hypertension is accompanied by diabetes mellitus, hypovolemia, or the use of diuretics, vasodilators and psychotropic drugs. Therefore, it is necessary to pay attention to the measurement of blood pressure in the recumbent and standing positions during the diagnosis and treatment of hypertension in the elderly. 5. Postprandial hypotension is defined as a decrease in systolic blood pressure of ≥20 mmHg within 2 h after a meal or a systolic blood pressure of ≥100 mmHg before a meal and <90 mmHg after a meal.
mmHg, and dizziness, syncope, angina pectoris and other symptoms related to hypotension after a meal. 6. Abnormal circadian rhythm of blood pressure In healthy adults, the blood pressure level at night is 10% -20% lower than that at daytime (arytenoid rhythm).
-20% (arytenoid blood pressure rhythm). Older patients with hypertension often have an abnormal circadian rhythm of blood pressure, as evidenced by a decrease in blood pressure at night of <10% (non-Arytenoid) or >20
The abnormal circadian rhythm of blood pressure is more likely to cause damage to the heart, brain, kidney and other target organs. The prevalence of non-ascending blood pressure in elderly hypertensive patients can be more than 60%. The abnormal circadian rhythm of blood pressure is more closely related to target organ damage in the elderly than in younger patients. 7. Office hypertension, also known as white coat hypertension, refers to the patient’s blood pressure measured by a doctor or nurse in the office systolic blood pressure ≥ 140 mmHg, or diastolic blood pressure ≥ 90
mmHg, but not at home on self-test or ambulatory blood pressure monitoring. Office hypertension is common in older adults and can lead to excessive antihypertensive therapy. For those with increased in-office blood pressure, blood pressure monitoring should be strengthened, and patients should be encouraged to take their own blood pressure at home and to perform ambulatory blood pressure monitoring if necessary to assess the presence of in-office hypertension. Calibrate sphygmomanometers when necessary to avoid measurement errors. Patients with in-office hypertension are often associated with metabolic abnormalities and increased cardiovascular and cerebrovascular risk. 8. Multiple diseases coexist and complications Elderly hypertension is often associated with atherosclerotic cardiovascular disease and other risk factors for cardiovascular and cerebrovascular disease, and some patients have multiple coexisting diseases. If blood pressure is not well controlled for a long time, it is more likely to cause or aggravate target organ damage, and significantly increase cardiovascular and cerebrovascular mortality and overall mortality. The clinical manifestations of hypertension and concomitant diseases in some elderly patients are atypical and easily missed, so a comprehensive assessment should be performed and reasonable treatment measures should be developed. Cerebrovascular disease is common in elderly patients, and screening and evaluation should be noted. If patients have ≥70% bilateral carotid artery stenosis or presence of severe intracranial artery stenosis, excessive blood pressure lowering or blood pressure fluctuations may increase the risk of ischemic stroke.