1. What are the characteristics of geriatric hypertension? Geriatric hypertension is common in clinical practice and refers to hypertensive patients aged 60 years or older with systolic blood pressure > 160 mmHg and/or diastolic blood pressure > 95 mmHg. Some of the hypertension in the elderly is a continuation of the hypertension in young and middle-aged people, while the other part is due to atherosclerosis, decreased elasticity and increased systolic blood pressure. Compared with young and middle-aged hypertension, elderly hypertension has the following characteristics: (1) The blood pressure of elderly hypertension fluctuates more, especially the systolic blood pressure. This is mainly due to the reduced sensitivity of vascular pressure receptors in elderly patients. (2) Vulnerable to postural changes, the incidence of postural hypotension is higher, and it is prone to occur in anti-hypertensive drug therapy, and it is more likely to occur when taking alpha-blockers that take into account the treatment of prostatic hyperplasia, such as terazosin and doxazosin, which is also related to the hypersensitivity of pressure receptors. (3) The elderly are prone to pseudohypertension due to atherosclerosis, and their blood pressure can be high when the peripheral arterial blood pressure is measured with a sphygmomanometer, while it is mostly within the normal range when the arterial blood pressure is measured directly by invasive methods. (4) Hypertension in the elderly is mainly due to elevated systolic blood pressure, which is more dangerous to the heart and more prone to heart failure, as well as to stroke. (5) The elderly are sensitive to reduced blood volume and sympathetic inhibition, which may be related to cardiovascular reflex damage in the elderly. (6) Older adults have lower neurological function and are more likely to experience depression with medication. (7) The elderly often have a combination of multiple chronic diseases, such as coronary heart disease and diabetes mellitus. In the drug selection should pay attention to these characteristics of the elderly, choose the appropriate drug for the characteristics of the elderly, both to achieve the purpose of treatment of hypertension, but also does not cause serious toxic side effects. 2.How to choose anti-hypertensive drugs for elderly hypertension? According to the characteristics of hypertension in the elderly, anti-hypertensive treatment should be different from that of hypertension in young and middle-aged people, and calcium antagonists are preferred, such as nifedipine (Baishin Tong, Neftar), amlodipine (Lowe’s, Pressida), felodipine (Boydin), etc. These drugs can effectively reduce systolic and diastolic blood pressure. Nifedipine has a stronger effect and is suitable for people with high blood pressure. It is available in regular tablets, extended-release tablets and controlled-release tablets, which have the same composition, while regular tablets have a short duration of action and need to be taken 3 to 4 times a day, nifedipine extended-release tablets and controlled-release tablets have a long-lasting effect and can maintain the antihypertensive effect for 24 hours. These advantages are in line with the tolerance characteristics of the elderly, so they are suitable for the treatment of hypertension in the elderly. Thiazide diuretics, such as hydrochlorothiazide, have good antihypertensive effects and can be used, but they are not suitable for people with diabetes and gout, and strong diuresis may also cause postural hypotension. Angiotensin-converting enzyme inhibitors (such as benazepril, fosinopril, etc.) and angiotensin receptor antagonists (such as cloxacin, irbesartan, etc.) have better efficacy in elderly hypertension without significant side effects, and can also be used. The above drugs can be applied individually or in combination. In general, if peripheral resistance is high and blood pressure is high, nifedipine can be used. Diuretics such as hydrochlorothiazide have milder effects and are suitable for patients with mild to moderate hypertension; for those with more recalcitrant blood pressure, calcium antagonists, converting enzyme inhibitors and diuretics are used in combination. Beta-blockers are contraindicated in elderly hypertensive patients with underlying sinus node pathology (e.g., sick sinus node syndrome), left heart insufficiency, and chronic obstructive pulmonary disease. Sympathetic ganglion blockers, such as methyldopa and colistin, are effective in elderly hypertension, but they are prone to blood pressure fluctuations and sudden drops and are generally contraindicated, only for moderate and severe hypertension where other antihypertensive drugs are ineffective. Lixin can induce or aggravate mental depression in the elderly, also should not be used. 3.How much is appropriate to reduce hypertension in the elderly? This is a question that has plagued cardiovascular physicians and patients for many years, and after a series of clinical studies, there is now a basic consensus. Several randomized trials with elderly subjects, such as Syst-Eur, Syst-China and Stone, have shown that antihypertensive treatment can lead to a significant reduction in cardiovascular event morbidity and mortality in elderly patients with hypertension, and reduce the blood pressure of the elderly to normal or near-normal range, and does not reduce cerebral blood flow perfusion and reduce cognitive decline in the elderly. Several major hypertension guidelines currently call for a reduction to less than 140/90 mm Hg in patients with general hypertension and less than 130/80 mm Hg in younger adults or in patients with diabetes and renal disease, and because “there is no evidence to warrant a revision of blood pressure control goals in older adults,” the hypertension control goals for older adults should be compared with those for younger adults. The control goal for hypertension in the elderly should be “the same” as that for young and middle-aged people, and the standard of less than 140/90 mmHg should be maintained. In the following cases, the target systolic blood pressure is 160-180/90-105 mmHg for acute cerebral infarction, 150-160/90-100 mmHg for acute cerebral hemorrhage, and the target value is the same as the JNC-7 standard when the carotid stenosis is <70%. The Chinese guidelines for the prevention and treatment of hypertension set the goal of lowering blood pressure in the elderly at 150/90 mm Hg, which can be further reduced to 140/90 mm Hg if tolerated. 4. What are the considerations in the treatment of hypertension in the elderly? In addition to the selection of appropriate drugs for the treatment of hypertension in the elderly, attention should also be paid to: ① The elderly are mostly accompanied by renal arteriosclerosis and varying degrees of renal decompensation, drug metabolism is relatively slow, the dosage of drugs should be small, starting from a small dose, generally can be controlled at about 1/2 to 2/3 of the conventional amount, so as not to cause drug accumulation or cause toxic side effects. (2) Elderly patients with hypertension mostly have systemic arteriosclerosis, avoid sudden drop in blood pressure and large fluctuations in blood pressure to avoid insufficient blood supply to the heart, brain, kidneys and other important organs due to low blood pressure. ③The elderly have poor blood pressure regulation, and should avoid using sympathetic ganglion blockers to prevent postural hypotension. ④Avoid the use of strong medullary collaterals diuretics, such as furosemide (tachyphylaxis) to avoid water-electrolyte disorders. ⑤ Elderly people have poorer myocardial contractility and sinus node function, so they should avoid using antihypertensive drugs that inhibit myocardial contraction and affect the cardiac conduction system alone. ⑥Some elderly people may have depression and should avoid the use of reserpine. (7) The restriction of sodium should be started gradually, because after the restriction of salt, the taste of the elderly will change and affect the appetite and damage the health. 5.What are the points of attention for the treatment of the concomitant diseases of hypertension in the elderly? Hypertension in the elderly rarely exists alone, but is combined with many chronic diseases, which is a characteristic of hypertension in the elderly. Since non-selective beta blockers have the potential to constrict the trachea, all beta blockers have the effect of slowing the heartbeat and blocking conduction. Combined with chronic obstructive pulmonary disease and heart block of degree II or higher, beta blockers should be avoided. Diuretics are not preferred for diabetic patients, mainly because they may cause metabolic disorders, increased blood uric acid, low potassium and sodium, low blood volume, and can also raise blood sugar. If the prostate is enlarged and there is no postural hypotension, alpha blockers can be used as appropriate. The use of non-hormonal anti-inflammatory drugs can cause sodium retention and aggravate hypertension, when a small dose of diuretics can be selected for joint application. 6.Does hypertension over 80 years old still need to be treated? It is well established that regular and effective treatment of hypertension under 80 years of age may reduce target organ damage and mortality. However, it is not clear whether treatment is needed for hypertension over 80 years of age. 80 years of age or older are divided into two types of hypertension, one is from young and middle-aged, i.e., a long history of hypertension, and this part of the patients follow the existing treatment, which is also recognized, because hypertensive patients can live to 80 years of age itself is strong evidence of the benefits of antihypertensive treatment. While others are later, the treatment of these people, now the beneficial effect of anti-hypertensive treatment is only theoretical speculation, there is no evidence to confirm, it is generally believed that the treatment should still be carried out, but the standard should not be too harsh, the principle of no discomfort symptoms, as close to normal as possible. 7.Can hypertension be treated surgically? There are two types of hypertension, primary and secondary. Primary hypertension is hypertension for which no cause can be found, which clinically accounts for about 95% of hypertension, while secondary hypertension is one for which a cause can be found, accounting for about 5% of hypertension. The hand-like treatment of primary hypertension has just started, and the purpose of lowering blood pressure is achieved by radiofrequency ablation of the sympathetic nerves in the renal arteries. According to the limited information available, this technique has promising prospects, and is currently mainly aimed at intractable hypertension, that is, adult hypertension that cannot be effectively controlled with more than 3 types of antihypertensive drugs. Secondary hypertension is potentially amenable to surgical intervention to achieve radical cure. The most common secondary hypertension is mainly of 4 types: (1) renal artery stenosis, caused by narrowing of one or both renal arteries, resulting in renal ischemia, which activates the so-called RAS system and raises blood pressure. Currently, the stenosis can be supported by stent placement with a spring-ring-like stent to restore blood flow to the kidney and bring down blood pressure. (2) Primary aldosteronism, mainly due to adrenal hyperplasia or tumor, increases aldosterone secretion, thus acting as water and sodium retention, causing elevated blood pressure, which can be restored to normal by surgical removal of the adrenal lesion. (3) Cushing's disease, is due to adrenal hyperplasia or tumor, which increases the secretion of glucocorticoid hormone, thus causing an increase in blood pressure, and blood pressure can be normalized by surgical removal of adrenal lesions. (4) Pheochromocytoma, also due to adrenal hyperplasia or swelling A, causes the adrenal glands to secrete a large amount of catecholamines, which raises blood pressure. Of course, secondary hypertension is more difficult to diagnose clinically and often takes many years to confirm the diagnosis. The main reasons for this are that the lesions are small, the available imaging is not sensitive enough, the biochemical changes are often transient, and it is difficult to take blood at the onset of the condition. Therefore, the diagnosis of secondary hypertension needs to be determined by an experienced physician at a regular hospital and should not be made on your own. Once secondary hypertension is diagnosed, it can be surgically cured. 8.How to confirm the diagnosis of secondary hypertension? Clinical diagnosis of secondary hypertension mainly relies on three aspects, (1) clinical symptoms, which are clues for doctors to find secondary hypertension, each kind of secondary hypertension has its own characteristics, such as primary aldosteronism often urinate more, low potassium, while pheochromocytoma is manifested as a large fluctuation of blood pressure, systolic blood pressure can exceed 200mmHg during an attack, accompanied by rapid heartbeat, sweating and other sympathetic excitement. symptoms, but as normal when not seized. (2) Imaging examinations, including ultrasound and CT, with emphasis on bilateral kidneys and adrenal glands. (3) Biochemical tests, possibly blood sampling to determine blood aldosterone, blood potassium, catecholamines, and urinary catecholamine metabolites, are the most valuable tests. Once the diagnosis is confirmed, the treatment problem is solved.