Speaker: Liu Zhe, Deputy Chief physician of geriatric Internal Medicine, Peking University Third Hospital

The Chinese Guidelines for the Management of Hypertension in the Elderly (2019) state that hypertension can be diagnosed when the patient is ≥65 years old and the systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg measured on 3 different days without the use of antihypertensive drugs. Older adults who have a definite diagnosis of hypertension and are receiving antihypertensive medications should also be diagnosed with senile hypertension, even if their blood pressure is <140/90 mm Hg.

Hypertension is an age-related disease, with the increase of age, the prevalence rate increases year by year. In the elderly population, the prevalence of high blood pressure is as high as 49%. That is to say, on average, one in two elderly people has high blood pressure. So, what are the characteristics of hypertension in the elderly?

Systolic hypertension is common. Hypertension in the elderly is common in systolic hypertension, that is, high pressure is usually said, and low pressure is normal or low.

The pulse pressure difference is large. With the increase of age, the elderly arteriosclerosis is obvious, the vascular elasticity is weakened, the blood volume in the artery is not buffered, resulting in a significant increase in "high pressure", "low pressure" is relatively low, and the difference between the two is the increase of pulse pressure difference. Often have elderly friends ask: "Doctor, there is no medicine to treat the pulse pressure difference?" In fact, all antihypertensive drugs reduce both systolic and diastolic blood pressure, and there is no drug that simply reduces systolic and diastolic blood pressure.

Day and night fluctuate greatly. The diurnal fluctuation of hypertension in the elderly is relatively large, and the abnormal circadian rhythm will affect the treatment effect. When it fluctuates sharply, it damages the heart and brain and significantly increases the risk of cardiovascular and cerebrovascular accidents. In addition, the elderly are susceptible to various factors such as posture, meal, mood, etc., resulting in postural hypotension and postprandial hypotension.

Prone to salt-sensitive hypertension. Due to the decline of taste function and gastrointestinal function in the elderly, the sensitivity to salt intake will also be reduced. Therefore, changes in salt sensitivity due to excessive salt intake may result in salt-sensitive hypertension. In addition, when the elderly have severe arteriosclerosis or calcification, it can be difficult to compress the brachial artery when the cuff is pressed, and the measured blood pressure value is higher than the measured blood pressure value in the artery, which is called false hypertension. This type of hypertension is poorly tolerated for antihypertensive drugs, and the body is prone to serious adverse reactions and complications after taking drugs, so the speed of blood pressure reduction should not be too fast or too low.

Cardiovascular and cerebrovascular events are easy to occur. Because the elderly are often combined with other cardiovascular and cerebrovascular risk factors, such as diabetes, hyperlipidemia, high uric acid and other metabolic abnormalities, elderly hypertensive patients are more likely to have heart, brain, kidney and other organ damage and cardiovascular and cerebrovascular events.

Hypertensive targets for older adults with hypertension are: age ≥65 years, blood pressure ≥140/90 mm Hg, initiation of antihypertensive medication in conjunction with lifestyle intervention to reduce blood pressure to <140/90 mm Hg. Age ≥80 years, blood pressure ≥150/90 mm Hg, immediately start antihypertensive medication, blood pressure should be reduced to <150/90 mm Hg, if well tolerated, further reduced to <140/90 mm Hg. Note that initial treatment is usually initiated with a smaller effective therapeutic dose, which is gradually increased as needed; As far as possible, use once a day, 24 hours of continuous antihypertensive effect of long-acting drugs, effective control of night and morning blood pressure.

In order to control pressure, the elderly should also eat a healthy diet, eat less than 5 grams of salt per day, eat more fresh vegetables and fruits; Proper exercise, reasonable aerobic exercise can effectively reduce blood pressure; Smoking cessation and alcohol restriction; Maintain an ideal weight and sleep quality. Bring about.