One of the classifications of hypertension is called geriatric hypertension. What are the characteristics of this type of hypertension and what are the differences in treatment compared to normal hypertension? After reading this explanation, you will understand.
1.Know your enemy: 5 characteristics of “elderly hypertension” know in advance
In general, the age of ≥ 65 years old, in the absence of antihypertensive drugs, non-same day three measurements of blood pressure, systolic blood pressure ≥ 140mmHg and (or) diastolic blood pressure ≥ 90mmHg, that is, the diagnosis of hypertension in the elderly. Its clinical characteristics mainly include the following aspects.
(1) Long duration of disease and insidious onset
(1) Long duration of the disease, insidious onset, slow progression, and because the elderly organism has a high tolerance for elevated blood pressure, the symptoms are mostly atypical, and many elderly people are even seen with complications as the first symptom, often resulting in delayed disease.
(2) Increased systolic blood pressure and increased pulse pressure
The prevalence of simple systolic hypertension in the elderly is 21.5%, accounting for 53.21% of the total number of elderly people with hypertension.
As we age, the atherosclerosis of large arteries increases and the elasticity and reserve capacity of blood vessels decrease, so that the resistance faced by the heart during contraction increases, while the buffering capacity of blood vessels against the rise in blood pressure decreases, it will easily lead to the advancement of blood flow reflection wave to systole, further increasing systolic blood pressure and decreasing diastolic blood pressure.
(3) Large and unstable blood pressure fluctuations
Due to the decrease of blood pressure regulation ability, the blood pressure level of the elderly is also easily affected by various factors, such as body position, meal, emotion, season or temperature, etc. This situation is also called “abnormal blood pressure fluctuation”. The main symptoms are.
– Blood pressure is higher when active and lower when quiet.
– It is higher in winter and lower in summer (the higher the blood pressure, the more pronounced the seasonal fluctuations).
– Postural hypotension, postprandial hypotension and abnormal circadian rhythm of blood pressure, postural hypertension, etc.
Because of the high fluctuation of blood pressure in the elderly, it will not only affect the treatment effect, but also significantly increase the risk of cardiovascular events when blood pressure fluctuates sharply.
(4) More target organ complications
Because of its long history, geriatric hypertension often coexists with a variety of diseases and has many complications. For example, it is complicated by coronary heart disease, heart failure, cerebrovascular disease, renal insufficiency, diabetes, etc.
The treatment of hypertension in the elderly is also complicated by the number of combined medications and increased drug interactions.
(5) Among them, white coat hypertension and pseudohypertension are more frequent
Because of the increased sympathetic nerve activity in the medical environment, elderly patients are more likely to have elevated blood pressure measured in the office, but normal blood pressure measured at home or ambulatory blood pressure monitoring, which is often referred to as “white coat hypertension.
In addition, the elderly are also prone to “pseudohypertension”, which is mainly seen in the elderly with severely calcified arteries.
Due to the increased calcification and stiffness of the arteries, it is difficult to compress the blood vessels after the cuff is inflated and pressurized, so the measured blood pressure is higher than the intra-arterial pressure.
2.How to cure: goals + principles + precautions, all should know
The previous understanding of the characteristics of elderly hypertension, then we only need to target these characteristics in the treatment or attention can be.
(1) elderly hypertension blood pressure control how much is considered normal?
– Elderly patients aged 65 to 79 years: recommended blood pressure is first lowered to <150/90mmHg, and if the patient tolerates it well, the target blood pressure is <140/90mmHg.
– Elderly people aged 80 (including 80) or older: it should be lowered to <150/90mmHg.
The aim of antihypertensive treatment for the elderly with high blood pressure is mainly to reduce the risk of cardiovascular disease in the elderly.
(2) Drug therapy follows 5 principles
Small dose: The initial treatment usually uses a smaller effective therapeutic dose, and the dose is gradually increased as needed;
Long-acting: as far as possible, use long-acting drugs with 1 time/d, 24h continuous antihypertensive effect to effectively control blood pressure at night and early morning.
Combination: If the efficacy of monotherapy is unsatisfactory, two or more low-dose antihypertensive drugs can be used in combination;
Moderate: most elderly patients require combination antihypertensive therapy, including the initial phase, but initial combination therapy is not recommended for debilitated elderly and elderly ≥80 years old
Individualized: the antihypertensive drugs suitable for patients are selected according to their specific conditions, tolerability, personal wishes and affordability.
(3) Different antihypertensive drugs have their own attention when used
First, in the absence of risk factors and target organ damage, non-pharmacological treatment is preferred.
Mainly, blood pressure is controlled by regulating diet and moderate exercise. If the blood pressure control is still not satisfactory after 2~3 months of trying, it should be treated with medication.
However, if there are risk factors and target organ damage in the elderly, drug treatment should be given early.
Second, there are five major classes of commonly used antihypertensive drugs, including calcium channel blockers, angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), diuretics, and beta-blockers.
Specific precautions in the use of drugs are as follows.
Diuretics: including thiazides, potassium-protective diuretics, etc.
Thiazide is commonly used, commonly used drugs are hydrochlorothiazide, but long-term application can cause a decrease in blood potassium and increase in blood sugar, blood uric acid, blood cholesterol, diabetes and hyperlipidemia patients should be used with caution, gout patients are prohibited.
Potassium-protective diuretics include aminopterin and spironolactone, which can cause hyperkalemia and should not be used in combination with angiotensin-converting enzyme inhibitors (ACEI), and are prohibited in patients with renal insufficiency.
Beta-blockers: These drugs have good antihypertensive and antiarrhythmic effects, and are more suitable for combined coronary artery disease, angina pectoris and hypertension after myocardial infarction.
However, it is prohibited for elderly people with heart block, asthma, chronic obstructive pulmonary disease and peripheral vascular disease.
In addition, long-term application of the drug should not be suddenly stopped to avoid a sudden rise in blood pressure.
Calcium channel blockers: Especially suitable for the elderly systolic hypertension. Commonly used drugs include verapamil, diltiazem and dihydropyridines.
The effect of dihydropyridines is mainly to block calcium channels in vascular smooth muscle, which can cause vasodilation and sympathetic activation, which is not good for the prevention of coronary heart disease. However, extended-release, controlled-release or long-acting formulations of dihydropyridines will allow the previously mentioned side effects to be significantly reduced and can be used for long-term treatment.
Angiotensin-converting enzyme inhibitors (ACEI): are particularly indicated in patients with hypertension with comorbidities such as heart failure, left ventricular hypertrophy, post-myocardial infarction, reduced glucose tolerance or diabetic nephropathy with proteinuria. However, it is contraindicated in patients with hyperkalemia, pregnancy, and renal artery stenosis. The most common adverse reaction is dry cough, which may disappear after discontinuation of the drug.
Angiotensin receptor blocker (ARB): The indications are the same as for ACEI, but without dry cough, with a smooth antihypertensive effect, and can be used in combination with most antihypertensive drugs.
References
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