1, systolic blood pressure (high pressure) increases, and high-low pressure difference increases.
The level of systolic blood pressure (hypertension) increases in the elderly, while the level of diastolic blood pressure (hypotension) decreases after the age of 60. Simple systolic hypertension (hypertension) is the most common type of hypertension in the elderly.
2. Blood pressure fluctuates greatly.
The stiffness of arterial wall in the elderly increases, while the sensitivity of baroreceptor decreases, and the regulation function of autonomic nervous system decreases, which makes the blood pressure of elderly hypertensive patients change more easily with the changes of mood, season and body position, showing postural hypotension, postural hypertension, morning hypertension and postprandial hypotension.
3. Pseudohypertension increases.
The daily blood pressure measured by finger cuff method is higher than the medial pressure of invasive artery, which is more common in the elderly with severe arterial calcification. The calcification and increased stiffness of brachial artery make it difficult for cuff to compress blood vessels after inflation and pressurization. The patient's blood pressure continues to rise without obvious target organ damage, or hypotension symptoms appear after antihypertensive treatment, but the cuff blood pressure is still high. The elderly should pay attention to pseudohypertension and avoid overtreatment.
4. Secondary hypertension is easy to be missed.
Most elderly patients with hypertension are primary hypertension, but don't ignore the secondary causes. The common secondary causes of elderly patients are atherosclerotic renal vascular disease and renal parenchymal lesions. If the blood pressure suddenly rises in a short time or the original hypertension is obviously aggravated, you should go to the hospital to check whether there is secondary hypertension.
5. Clinical hypertension or white coat hypertension.
The elderly patients are nervous in the medical environment, and their sympathetic nerve activity is enhanced, which is prone to the increase of blood pressure measured in outpatient department, while the self-measured blood pressure or ambulatory blood pressure monitoring at home is normal. Therefore, elderly patients are encouraged to actively carry out home self-test blood pressure, and those who have the conditions to carry out ambulatory blood pressure monitoring.
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Treatment and management of hypertension in the elderly
Age ≥65 years old, blood pressure was measured three times on the same day without using antihypertensive drugs, and systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥90 mmHg can be diagnosed as senile hypertension.
Under normal circumstances, antihypertensive therapy is beneficial to the cardiovascular system of elderly patients with hypertension, but for elderly patients with weak constitution, intensive hypotension will increase the risk of postural hypotension, which may lead to the risk of falling and syncope. Therefore, the elderly hypertension should be comprehensively evaluated by doctors before treatment, and should be closely observed and followed up after treatment.
1. Preliminary evaluation of elderly patients with hypertension.
The elderly should go to the hospital in time when they find that their blood pressure rises. Doctors should evaluate the patient's blood pressure level, vital organ function, risk factors of concurrent diseases and cardiovascular diseases. Doctors should also assess the weakness of patients, especially those over 80 years old, according to their weight changes, walking speed and physical activity ability, and understand the treatment tolerance.
2. Non-drug therapy.
Elderly hypertensive patients should have lifestyle intervention, eat less salt, eat more fresh fruits and vegetables, and exercise properly. However, due to the weakened physiological function of the elderly, it is often accompanied by osteoporosis and poor nutritional status. We should be cautious when limiting diet and losing weight to avoid the influence of excessive control on the quality of life, leading to electrolyte disorder and malnutrition.
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3. medication.
Long-acting drugs are the first choice for antihypertensive drugs in the elderly, starting from a small dose and gradually increasing, and the antihypertensive speed should not be too fast. At the initial stage of treatment and after adjusting the scheme, we should pay attention to whether there are symptoms related to cerebral circulation hypoperfusion, postural hypotension and myocardial ischemia. Commonly used antihypertensive drugs include calcium channel blockers, angiotensin converting enzyme inhibitors, angiotensin receptor antagonists, diuretics, beta blockers and fixed compound preparations composed of the above drugs. In addition, α receptor blockers can be used as adjuvant drugs for patients with benign prostatic hyperplasia and intractable hypertension.
4. Treatment objectives.
At present, domestic and foreign guidelines set different antihypertensive targets according to age, which are generally divided into age ≥65 (or 60 years old) and age ≥80 years old. At the same time, considering the physiological age, physical weakness, combined clinical diseases and treatment tolerance of the patients, the elderly patients with physical weakness should be given a relaxed antihypertensive goal, and the elderly patients with good health should try their best to achieve a positive antihypertensive goal.
According to "Guidelines for the Management of Hypertension in the Elderly in China 20 19", the target blood pressure is recommended for elderly patients aged 65-79.
Hypertension in the elderly is very common, which can damage important organs such as heart, brain and kidney, and is an important risk factor for stroke and coronary heart disease. Old people should monitor their blood pressure regularly. If blood pressure is found to be elevated, you should go to a regular hospital for treatment under the guidance of a doctor. At the same time, we should adopt a healthy lifestyle, don't stop taking drugs casually, and don't listen to the rumor of "radically curing hypertension". I wish every elderly person can control their blood pressure reasonably and get a higher quality of life.