Myth 1 Fear of low diastolic blood pressure The definition of geriatric hypertension is age 60 years or older, blood pressure persistent or more than 3 times on the same day as blood pressure systolic pressure, except for age, there is no difference in the definition of hypertension with ordinary adults. The difference is that there is another type of hypertension specific to older patients, namely geriatric simple systolic hypertension, which refers specifically to cases where the systolic blood pressure is ≥140 mmHg and the diastolic blood pressure is <90 mmHg. The reason for simple systolic hypertension in the elderly is that arterial vascular elasticity deteriorates with age and diastolic blood pressure slowly decreases after age 60, which in turn leads to an increase in pulse pressure. In this case, many patients and even doctors will listen to the high systolic pressure because of the fear of lowering the pressure while causing the diastolic pressure to be too low, so that the lowering of the pressure does not reach the target. Investigations have shown that systolic blood pressure is an important predictor of the risk of cerebrovascular disease and coronary heart disease, and that the harm to target organs such as the heart, brain and kidney exceeds the effects of elevated diastolic blood pressure. Therefore, if there is no contraindication to control "systolic blood pressure below 150 mmHg, or lower it further if tolerated" to better protect the target organs of elderly patients. In addition, in clinical practice, we have also found that the systolic blood pressure decreases relatively more in elderly patients with hypertension, resulting in a reduction in pulse pressure. Therefore, reasonable administration of antihypertensive drugs can usually control systolic blood pressure and does not necessarily lead to low diastolic blood pressure or even cause insufficient blood supply to vital organs. In addition, with the prolongation of treatment, some patients will be because the arterial elasticity improves but the diastolic blood pressure has increased. Another characteristic of elderly hypertension is that blood pressure fluctuates greatly, and elderly patients with hypertension often have left ventricular hypertrophy, ventricular arrhythmias, coronary arteriosclerosis and intracranial atherosclerosis. Therefore, extra caution is needed when treating elderly patients with hypertension. Not only should sitting blood pressure be routinely measured during antihypertensive therapy, but also standing blood pressure should be measured to assess the postural effects of antihypertensive therapy to avoid postural hypotension and excessive hypotension. If postural hypotension exists, the blood pressure should be judged according to the standing blood pressure to determine whether the blood pressure reaches the standard. For elderly patients with fluctuating blood pressure, ambulatory blood pressure monitoring can help to understand the fluctuation, and can be used as a routine examination item for diagnosis and efficacy monitoring of elderly hypertensive patients when conditions permit. Myth 3: "Immediate results" Due to the characteristics of elderly patients with hypertension and other chronic diseases, their ability to tolerate blood pressure fluctuations is very limited, so whether they are treated with medication or non-pharmacological treatments such as weight reduction and exercise, do not emphasize "medicine to the disease and immediate results". Antihypertensive drugs should be started in small doses and the speed of lowering blood pressure should not be too fast. Since patients often have multiple coexisting diseases and mostly have other cardiovascular risk factors or target organ damage at the same time, the selection of therapeutic drugs should also be done carefully, and the efficacy and side effects should be closely observed after medication. It is important to note that many doctors and patients in the clinic are so eager to cure the disease that after choosing a drug for a few days and seeing that the blood pressure does not reach the standard, they think that the drug is not suitable and quickly change the drug. In fact, a reasonable antihypertensive treatment for elderly patients should gradually put blood pressure control in place within 4 to 8 weeks, and then maintain it for a long time. Therefore, the use of antihypertensive drugs in the short term does not mean that the drug is ineffective for this patient, but whether it is effective needs to be observed for a period of time before drawing a conclusion. There are five major classes of antihypertensive drugs that are commonly used, and so far all elderly people can choose them, among which calcium antagonists and diuretics are more effective in lowering blood pressure and have fewer side effects. Calcium antagonists long-acting CCB have fewer side effects and no adverse effects on metabolism. There are no absolute contraindications, and it can be used in combination with other 4 types of antihypertensive drugs. The combination of multiple antihypertensive drugs is recommended for the elderly to lower their blood pressure to reach the target, with the aim of reducing the side effects of each drug. In addition, the elderly should weigh the advantages and disadvantages of medication, should fully evaluate the impact of concomitant diseases, and choose the appropriate antihypertensive drugs according to individual characteristics.