For elderly patients with hypertension, the blood pressure reduction target cannot be "one size fits all" and different situations should be treated differently

A friend in his 70s told Huazi that he had encountered problems with blood pressure treatment. Several of his friends had high blood pressure and they always exchanged their blood pressure-lowering experiences or health-preserving secrets. Those friends said that blood pressure had to be lowered to below 140 mmHg to be considered normal. He checked some information himself and also found that blood pressure below 140 mmHg was within the normal range.

But after he took antihypertensive drugs and lowered his blood pressure to below 140 mmHg, he felt listless every day, his brain was groggy, and his legs felt weak when he walked. One day he forgot to take his antihypertensive drugs, but he felt much better. However, when he measured his blood pressure, it had risen to 160 mmHg. So he was very confused and asked Huazi whether he should continue to take the antihypertensive drugs.

1. Characteristics of hypertension in the elderly Huazi told him that he was over 65 years old and had hypertension in the elderly. He belonged to a special group in hypertension treatment and had different characteristics from normal hypertension. The characteristics of hypertension in the elderly are mainly increased systolic blood pressure (high pressure), decreased diastolic blood pressure (low pressure), and increased difference between pulse pressures. Blood pressure fluctuates greatly, the circadian rhythm of blood pressure is abnormal, and postural hypotension and postprandial hypotension are prone to occur.

Therefore, in view of the characteristics of hypertension in the elderly, during antihypertensive treatment, it is necessary to emphasize that systolic blood pressure meets the target, while avoiding excessive lowering of blood pressure. On the premise that the antihypertensive treatment can be tolerated, blood pressure should be gradually lowered to avoid lowering blood pressure too quickly.

Second, the blood pressure reduction target for the elderly cannot be "one size fits all". For the diagnosis of hypertension, the standard is equal to or above 140/90 mmHg at any age. In many hypertension guidelines, the goal is to reduce blood pressure to below 140/90 mmHg. However, for elderly hypertensive patients, due to different physical conditions, different underlying diseases, and different tolerance to blood pressure, the blood pressure reduction target cannot be "one size fits all" when treating blood pressure.

For elderly people over 65 years old, the initial blood pressure control target can be set at 150/90 mmHg during antihypertensive treatment. After reaching the target, observe for two weeks. If the current blood pressure can be tolerated, further reduce it to 140/90 mmHg by adjusting the dose or medication. Continue to observe for two weeks. If it can still be tolerated, further reduce it to 130/80 mmHg. For young people, it can be further reduced, but for the elderly, blood pressure can be controlled at 130/80 mmHg.

For the elderly with cerebral arteriosclerosis and stenosis, they need to maintain a higher blood pressure to ensure blood supply to the brain. These people's blood pressure may need to be maintained above 160/100 mmHg. If it drops to normal standards, the brain will have insufficient blood supply, causing symptoms of cerebral ischemia such as dizziness, black vision, and tinnitus.

Because the heart mainly supplies blood during diastole, low diastolic pressure may affect the heart's blood supply. The characteristic of hypertension in the elderly is low diastolic pressure and increased pulse pressure, so elderly hypertensive patients should pay attention to the diastolic pressure when controlling the diastolic pressure. When the diastolic pressure is less than 60 mmHg, it is necessary to closely monitor whether there are symptoms such as chest tightness and palpitations, and gradually reduce the diastolic pressure to the standard while ensuring that there are no abnormalities.

3. Precautions when using antihypertensive drugs Everyone should understand that maintaining a steady blood pressure reduction process is more important than quickly controlling blood pressure. When elderly hypertensive patients are undergoing antihypertensive treatment, the drug should be started with a small dose and gradually increased. It usually takes several months to gradually control blood pressure within the standard range. Do not rush. If dizziness, blacking out, palpitations, chest tightness, etc. occur during the blood pressure reduction process, the dose should be stopped or reduced.

In antihypertensive treatment, long-acting antihypertensive drugs should be selected as much as possible, which can reduce the number of medications and improve medication compliance. Moreover, long-acting drugs can maintain a higher blood drug concentration for a longer period of time, and the effect of all-day blood pressure control is also better. Most patients with hypertension need to adopt multi-drug combination therapy, which is more effective than single-drug therapy, and the drug effects can complement each other and reduce the occurrence of side effects.

To sum up, the elderly have more basic diseases and great physical differences. The blood pressure reduction target cannot be "one size fits all". Different blood pressure reduction targets need to be set according to the actual situation. Drugs should be selected under the guidance of doctors to gradually reduce blood pressure, rather than blindly following other people's medication experience. When using antihypertensive drugs, if you find any problems, you should consult a doctor or pharmacist in time. I am pharmacist Huazi, welcome to follow me and share more health knowledge.