Hypertension is significantly more prevalent in the elderly population and is one of the most serious chronic diseases affecting their health. It is generally believed that hypertension is an unavoidable pathophysiological change in the aging process of the elderly, and is also an important risk factor for the elderly to be prone to cerebrovascular accidents (stroke) and coronary heart disease. 1, the main characteristics of blood pressure in elderly patients
The most important characteristic of blood pressure in the elderly is that the high pressure (systolic) is getting higher, the low pressure (diastolic) is not high or even low, and the pulse pressure is getting larger. Specifically, systolic blood pressure in the elderly increases with age, while diastolic blood pressure decreases slowly after the age of 60. The incidence of pure systolic hypertension increases with age, while the incidence of stroke rises sharply. Pulse pressure is an indicator of arterial elasticity. Increased pulse pressure is mainly due to decreased vascular elasticity caused by long-term atherosclerosis and is an important predictor of cardiovascular events. 2. Elderly patients are prone to postural hypotension. Commonly used postural hypotension is defined as a decrease in systolic blood pressure >20 mmHg or diastolic blood pressure >10 mmHg within 3 minutes of changing position to upright, accompanied by symptoms of hypoperfusion. Therefore, those who take vasodilators or psychotropic drugs are prone to postural hypotension, so it is better to be in bed or sitting position when taking medication to prevent vertigo or fall when hypotensive. 3. Abnormal circadian rhythm of blood pressure. The blood pressure of normal people is high in the day and low in the night, with double peaks and valleys, i.e., it rises significantly in the morning after waking up and waking up, and reaches a peak at 8:00-10:00; thereafter it falls, and rises again at 16:00-18:00; later it falls slowly until 2:00-3:00 a.m. when it reaches its lowest value, i.e., the “aryepiglottic” phenomenon. Most elderly hypertensive patients are prone to abnormal blood pressure circadian rhythm, often accompanied by nocturnal blood pressure rise, blood pressure rhythm can be shown as a non-ary type, or even anti-ary type. 4, elderly hypertensive patients with multiple diseases coexist. If the blood pressure of elderly hypertensive patients is not well controlled for a long time, they are prone to target organ damage, such as coronary heart disease, ischemic nephropathy and intermittent claudication; elderly people are more prone to stroke due to poor vascular elasticity and weakened auto-regulation. 5, elderly patients with hypertension need to be careful with medication. Due to the aging of the physiological function of the elderly, which affects the distribution of drugs in the body, metabolism and the ability of the kidneys to exclude, and make the effect of drugs significantly reduced. In addition, blood pressure lowering drugs do not have drugs that lower systolic blood pressure alone and do not affect diastolic blood pressure. However, the magnitude of blood pressure reduction by blood pressure-lowering drugs depends on the degree of elevated basal blood pressure before the drug is used. The higher the blood pressure before the drug is used, the more significantly the blood pressure is lowered by the antihypertensive drug. Therefore, in elderly people with purely elevated systolic blood pressure, blood pressure-lowering drugs have a significant decrease in systolic blood pressure and a small or minimal effect on diastolic blood pressure. In contrast, increased systolic blood pressure is the greatest risk of stroke. Do not be afraid to control systolic blood pressure well with blood pressure lowering drugs because of excessive concern about diastolic blood pressure decrease. To ensure blood perfusion to vital organs, systolic blood pressure can be lowered to below 150 mmHg in the elderly (over 80 years old).