Increased pulse pressure difference is the main manifestation of simple systolic hypertension in the elderly, this type of hypertension patients often exceed 60 mmHg, defined as increased pulse pressure difference, all the various factors affecting the systolic or diastolic pressure, may cause an increase in pulse pressure difference, the reason is determined by the characteristics of hypertension in the elderly: 1, due to atherosclerosis, arterial wall elasticity is reduced, the elastic expansion capacity of the large arteries during the systolic period Weakened due to atherosclerosis, arterial wall elasticity, systolic expansion capacity of the large arteries, resulting in an increase in systolic pressure, diastolic elastic retraction amplitude is weakened, vascular elasticity is not enough to lead to lower diastolic pressure, so the pulse pressure difference increases. Therefore, the elderly are often characterized by elevated systolic blood pressure; 2. The abnormal rhythm of blood pressure fluctuations between day and night, increased blood pressure fluctuations, greater damage to the heart, brain, kidneys and other important organs, prone to morning peak hypertension, non-lancelet hypertension; 3. 5, often combined with a variety of diseases, more likely to occur organ insufficiency, because of the treatment of a variety of diseases, the use of more drugs, easy to occur drug interactions, resulting in an increase in adverse drug reactions. The above physiological changes and pathological changes determine the appearance of a large pulse pressure difference in elderly patients with hypertension, is the main reason for some of the hypertensive friends to seek medical treatment, through the research in recent years found that some non-hypertensive drugs and certain antihypertensive drugs have the effect of improving the elasticity of the large arteries, can make the pulse pressure difference reduced, bringing the gospel for the majority of hypertensive patients. The goal of treatment of monosystolic hypertension is to selectively lower systolic blood pressure without lowering or even raising diastolic blood pressure and to reduce the pulse pressure difference. The strategy of treatment is that antihypertensive drugs should be chosen that have the ability to reduce arterial stiffness and improve the elasticity of large arteries. So what are the drugs have such a function? First, nitrate drugs: refers to the long-acting nitrate drugs – isosorbide 5-mononitrate tablets, such as Imodium, Xinkang tablets, etc. Mechanism of action: release nitric oxide, dilate blood vessels, improve endothelial function, dilate veins mainly, increase blood storage in venous system, properly reduce blood flow in arterial system, also dilate arteries, reduce contraction spasm of arteries, improve elasticity of large arteries and enhance diastolic function of arteries. Experimental evidence: nitrate 60-120mg/day, plus other antihypertensive drugs, can make the systolic blood pressure drop more than 16mmHg, pulse pressure difference reduced by 13mmHg. Second, calcium antagonists: refers to the long-acting calcium antagonists: for example, amlodipine besylate, levamlodipine, felodipine, lacidipine, nifedipine extended-release tablets. It can significantly reduce systolic blood pressure, with limited reduction in diastolic blood pressure, resulting in a reduction in pulse pressure difference. Mechanism of action: Reduce the concentration of calcium ions in vascular smooth muscle, make vascular smooth muscle diastolic, arterial vasodilatation, release the spastic contraction of arteries, make systolic pressure drop; improve vascular endothelial function, increase the synthesis and release of nitric oxide, reduce the production of oxygen free radicals, inhibit vascular smooth muscle proliferation and migration, antioxidant, anti-atherosclerosis. Therefore, calcium antagonists can enhance the elasticity of large and small arteries, improve the elasticity of large arteries and reduce the pulse pressure difference. Third, statins are lipid-lowering drugs: mainly refer to atorvastatin, pravastatin, resevastatin, lovastatin, simvastatin and so on. Using the multi-effect of statin, improve vascular endothelial function, antioxidant effect, stop and reduce the formation of atheroma plaque, can reduce systolic blood pressure, so that the pulse pressure difference is reduced. Mechanism of action: up-regulate the expression of nitric oxide gene, increase the synthesis and release of nitric oxide, reduce the production of oxygen free radicals, and produce the effect of vasodilation. Experimental studies have proved that statin can improve the elasticity of large and small arteries, soften the blood vessels and reduce the pulse pressure difference. Fourth, diuretics: mainly refers to hydrochlorothiazide, etc., indapamide, etc. In addition to diuretic effect, long-term application can reduce vascular edema, prevent collagen aggregation, and relieve arterial stiffness. Mechanism of action: High sodium diet and increased sodium ions in tissues can thicken the arterial wall and increase the thickness of the interstitial membrane, while diuretics can increase sodium excretion and improve the structural and functional remodeling of the arterial wall caused by elevated sodium ions. Experimental studies have proved that diuretics reduce systolic blood pressure much more than diastolic blood pressure. Folic acid: Folic acid deficiency causes a special type of hypertension called “H-type hypertension”, which is dominated by elevated systolic blood pressure. The decrease of folic acid makes the body homocysteine rise, this substance can damage the vascular endothelial function, so that the synthesis and secretion of nitric oxide is reduced, vascular endothelial cell dysfunction; it can also make the elastic protein decomposition of the dynamic wall accelerated, vascular stiffness increased, but also make vascular smooth muscle cells proliferate, together with the loss of vascular elasticity, atherosclerosis aggravated, so that blood pressure increases. Experimental evidence: Enalapril combined with folic acid can reduce the systolic blood pressure and narrow the pulse pressure difference in H-type hypertension. Specific application considerations: Lifestyle changes and interventions are the basis, together with drug therapy, both of which complement each other and are indispensable. The five major classes of antihypertensive drugs recommended by the guidelines are still preferred to bring blood pressure up to standard. The currently accepted target blood pressure is 140-150/60-90 mmHg, and diastolic blood pressure should preferably not be lower than 60 mmHg. Combining multiple drugs and multi-target treatment of hypertension is consistent with the pathogenesis of hypertension. Slowly, appropriately and gradually bring blood pressure under control to prevent large ups and downs. Geriatric hypertension must master the principle of individualized medication, with specific analysis of the type of hypertension, what organ function damage has occurred, previous and recent blood pressure levels, what other risk factors currently exist, other comorbid diseases and their relationship to hypertension, the presence of allergic drugs, drug interactions, and other issues. For example, in the case of combined coronary artery disease, one may choose to combine nitrates, calcium antagonists, and statins; in the case of combined cardiac insufficiency, diuretics; in the case of combined carotid atherosclerosis, calcium antagonists and statins; and in the case of combined hyperhomocysteinemia, folic acid. In summary, for patients with simple systolic hypertension, when there is a large pulse pressure difference, in addition to a reasonable choice of antihypertensive drugs, according to the specific circumstances of individual patients, you can consider the use of nitrates, calcium antagonists, statin lipid-lowering drugs, diuretics, folic acid, etc., to improve the elasticity of the arteries and reduce the pulse pressure difference.