1.Is it normal for the elderly to have increased blood pressure? Hypertension is a common disease in the elderly. Part of the elderly hypertensive patients is the continuation of the pre-geriatric hypertension, manifested as elevated systolic blood pressure or elevated both systolic and diastolic blood pressure; most of them have gradually increased systolic blood pressure with age, while diastolic blood pressure is not high or low, that is, simple systolic hypertension. With age, the dilatation and compliance of the large arteries decreases, the middle elastic fibers decrease, the collagen fiber content increases, and the middle calcium deposits and intimal atherosclerosis cause the large arteries and their major branches to become less elastic. It shows large fluctuations in blood pressure and a large pulse pressure difference. According to the new criteria, systolic blood pressure ≥ 140 mmHg and diastolic blood pressure < 90 mmHg are considered simple systolic hypertension, and hypertension in the elderly should be treated accordingly. 2. Are the diagnostic criteria for hypertension in the elderly the same as those for hypertension in the general population? Reviewing the definition of hypertension diagnostic criteria in hypertension guidelines, we can find that there is a gradual process of understanding hypertension in the elderly. 1978 WHO hypertension diagnostic criteria for systolic blood pressure ≥ 160mmHg and diastolic blood pressure ≤ 95mmHg, this criterion has been used for 15 years, in 1993 WHO defined hypertension as blood pressure ≥ 140/90mmHg. 1997 JNC6 defined hypertension as blood pressure ≥140/90mmHg, and the diagnostic criteria for simple systolic hypertension were systolic blood pressure ≥140mmHg and diastolic blood pressure <90mmHg. 2003 and 2007 European hypertension guidelines proposed the diagnostic criteria for hypertension as ≥140/90mmHg, without separate diagnostic criteria for hypertension in the elderly, implying that the diagnostic criteria for hypertension in the elderly are the same as general population. However, age is included as an independent risk factor in the risk stratification, reflecting the importance of increased blood pressure due to increasing age. 3. Why is hypertension more volatile in the elderly than in younger people? Blood pressure fluctuations are greater in older hypertensive patients than in younger hypertensive patients, especially in systolic blood pressure, which is mainly related to the reduced sensitivity of pressure receptors and decreased pressure regulation in the elderly. This is mainly manifested in four areas: nocturnal hypertension, early morning hypertension, postprandial hypotension, and upright hypotension. Increased blood pressure variability is an independent risk factor for cardiovascular events in elderly hypertension. The above characteristics of geriatric hypertension make the risk of target organ damage and related death significantly higher. 4.What are the clinical characteristics of geriatric hypertension and the considerations in its treatment? Hypertension is a common disease in the elderly, and its pathogenesis, clinical manifestations and the choice of therapeutic drugs have their own characteristics: (1) Blood pressure fluctuates widely, whether it is systolic blood pressure, diastolic blood pressure, pulse pressure difference, all fluctuate more than young people, even if the same day blood pressure also varies greatly. (2) The diagnosis of hypertension should be cautious, according to the ambulatory blood pressure study reported that almost 25% of the elderly systolic hypertension for simple clinic hypertension. (3) The duration of hypertension is long, with many complications of heart, brain and kidney, and more accompanying chronic diseases. The principles and methods of drug treatment are as follows: (1) Individualized principle: individualized treatment is especially important for elderly patients with hypertension. the WHO/ISH and the US JNC-7 recommend the application of low-dose diuretics and long-acting calcium channel blockers. The benefits of antihypertensive therapy for elderly patients with hypertension are well established. increased blood pressure before the age of 75 should be treated; mild hypertension over the age of 80, if there are no specific symptoms, generally do not give antihypertensive treatment; with a variety of other diseases, according to the different pathophysiological changes, the strengths and weaknesses of the choice of drugs. (2) The starting dose should be small and the speed of blood pressure lowering should be slow: generally speaking, the initial dose is about 1/2 of that of young people, and the magnitude of blood pressure lowering should not be too large to avoid adverse consequences by affecting the blood perfusion of vital organs. In elderly people, if the blood pressure is lowered too fast, it can cause upright hypotension and even transient cerebral ischemia or fall and bone precipitation and other unexpected situations. (3) Pay attention to the quality of life: the metabolism and internal environmental balance of the elderly body is physiologically degenerated, prone to adverse drug reactions. The application of antihypertensive drugs with inhibitory effects on the central nervous system, such as reserpine, colistin and methyldopa, should be avoided as much as possible to avoid adverse reactions such as mental depression. Drugs that cause upright hypotension, such as high-dose diuretics, alpha-blockers and hydrazidiazide, should be avoided. 5.What are the two main categories of antihypertensive drugs? One category is volume-dependent antihypertensive drugs, such as diuretics and calcium antagonists (CCB); the other category is RAAS and sympathetic inhibition-based antihypertensive drugs, such as angiotensin II receptor inhibitors (ACEI), angiotensin II receptor antagonists (ARB), and beta-blockers. Volume-based antihypertensive drugs can lower blood pressure through diuresis and vasodilatation, and among these 2 classes of drugs, they are divided into short-acting, intermediate-acting and long-acting. Short- and medium-acting CCBs or diuretics have partial sympathetic activation while lowering blood pressure, and high doses of diuretics may also cause hypokalemia and hyperuricemia. ACEI, ARB, and beta-blockers have the effect of lowering blood pressure and inhibiting sympathetic and improving RAAS, and have a better effect on renal hemodynamics, but these drugs are not suitable for patients with renal artery stenosis and bradycardia. The combination of drugs with different mechanisms of action has synergistic antihypertensive features and can reduce some adverse effects of single drugs.