hypertension is a common problem for the elderly. The body of the elderly is relatively fragile, so more attention should be paid to it. Then how should the elderly who have high blood pressure use drugs? What should the elderly pay attention to in hypertension? Let's take a look
The elderly are the high-risk population of hypertension. The diagnosis standard of hypertension in the elderly is age & Ge; 65 years old. The blood pressure was measured three times on different days. The average systolic pressure & Ge; 140mmHg and / or diastolic pressure & Ge; 90mmHg. If the elderly suffer from high blood pressure, necessary measures should be taken under the guidance of doctors, such as non drug treatment or drug treatment.
Professor said that the elderly hypertension is mainly systolic hypertension, prone to postural hypotension, postprandial hypotension, white coat hypertension and other characteristics. Therefore, the treatment of elderly hypertension also needs to choose appropriate antihypertensive drugs according to its characteristics.
The first diagnosis of hypertension below grade II does not advocate the immediate use of drug treatment. Generally, the first choice is to improve the lifestyle of non drug treatment (low sodium diet, weight loss, blood glucose control, blood lipid, smoking cessation, alcohol restriction, mental pressure relief, proper regular exercise, etc.) for three months. If there is no improvement after three months, drug treatment is needed; But the hypertension above the second grade needs the non drug treatment + the drug treatment from the beginning.
So, what is the best medicine for elderly hypertension? Professor Li said that the specific choice should promote individualization. If the renal function of the elderly patients with hypertension is low, the diuretics and calcium orange antagonists have better effect; if the renal function is normal, thiazide diuretics should be selected to avoid the strong loop diuretics (furosemide, etc.), but attention should be paid to the low blood potassium and its adverse effects on the metabolism of sugar and fat; If the activity of renin in the elderly patients is low, we can choose the invertase inhibitor, which can not only effectively reduce blood pressure, but also benefit insulin resistance, sugar and fat metabolism; for the patients with angina and tachyarrhythmia, we can use beta receptor blocker, but because it can cause heart rate slowing, conduction block, add the center of gravity dysfunction, it is not the first choice drug. In addition, the elderly should be careful with drugs that may cause orthostatic hypotension, such as guanidine and & alpha; receptor blockers.
2. What should we pay more attention to in the elderly with hypertension
Note 1: pay attention to orthostatic hypotension.
Elderly people are prone to orthostatic hypotension. Therefore, when the elderly patients become dizzy and dizzy from lying on their back to upright position in the treatment of blood pressure reduction, it is suggested that the possibility of orthostatic hypotension should be paid more attention to.
The elderly patients with hypertension should pay attention to self-care, reasonable diet, proper exercise in strict accordance with the requirements of the elderly hypertension precautions, and adhere to the "life-long medication" under the guidance of doctors. It is important to prevent and delay the occurrence of complications
Note 2: diet should be reasonable.
The principle of low salt, low fat and high protein should be paid attention to in the diet of elderly patients with hypertension. The daily intake of salt should not exceed 10 grams, preferably less than 5 grams. Limit the intake of animal fat and cholesterol, mainly edible vegetable oil, which is not only conducive to the prevention of atherosclerosis, but also easy to control blood pressure. Take in a proper amount of protein. In addition to the protein provided by grains, you should also give milk, lean meat, fish and other foods. At the same time, eat more potassium rich foods, such as vegetables and fruits, to supplement vitamins and regulate the body electrolyte balance, to ensure smooth stool. A certain amount of potassium and calcium intake can reduce the sensitivity of cardiovascular system of the elderly to sodium salt, thus reducing blood pressure.
Note 3: exercise should be moderate and sleep should be sufficient.
Elderly patients with hypertension should be able to do daily activities, appropriate activities, work and rest, sleep enough. Regular and scientific life style can maintain stable blood pressure; overwork can increase blood pressure and aggravate the disease. The elderly should get enough sleep for 8-9 hours every day.
Note 4: Dress loosely.
The clothes and trousers of the elderly patients with hypertension should not be too tight and small, and it is better to be soft and loose. It's better to wear pure cotton clothes with good air permeability, which is easy and warm. The belt and tie should not be tied too tightly to avoid blood pressure fluctuation.
Note 5: the spirit should be happy and the mood should be stable.
Bad mood can make the heart beat faster and blood pressure higher. Therefore, elderly patients with hypertension should keep a calm state of mind and avoid emotional agitation and over tension.
Note 6: insist on taking medicine, do not stop taking medicine by yourself.
Drug therapy is the main treatment of hypertension in the elderly. The elderly patients with hypertension should take antihypertensive drugs according to the doctor's orders, so that the blood pressure is gradually controlled within the normal range. In the application of antihypertensive drugs, the elderly patients should sit up and stand up slowly.
3. One of the three major causes of death in the elderly with hypertension
In China, cerebrovascular disease, heart disease and tumor are the three major causes of death of the elderly, and cerebrovascular disease ranks first. The harm to brain mainly comes from hypertension, followed by arteriosclerosis. Therefore, the harm of hypertension to the brain is the most dangerous factor that seriously threatens human health and life.
The harm of hypertension to brain is mainly to affect cerebral artery.
In the early stage of hypertension, there was only systemic arteriospasm, and there was no obvious organic change in blood vessels. If the blood pressure continues to increase for many years, the arterial wall will lose elasticity due to hypoxia, malnutrition, increased intimal permeability, and gradual hardening of the vascular wall. The lumen gradually narrowed and occluded. The degree of vascular lesions in various organs is different, and the lesions in brain, heart and kidney are the most serious. However, the muscularis and adventitia of the small arteries in the brain are underdeveloped, the walls of the arteries are weak, the automatic regulation function of the blood vessels is poor, in addition to the long-term increase of blood pressure, the improper use of mental tension or antihypertensive drugs, the violent fluctuation of blood pressure, the occurrence of cerebral vasospasm and other factors can promote the occurrence of cerebrovascular diseases.
Clinically, the diseases of cerebral blood vessels caused by hypertension mainly include cerebral hemorrhage, hypertensive encephalopathy and lacunar infarction. Cerebral hemorrhage is the most common complication of advanced hypertension. The location of cerebral hemorrhage, the amount of hemorrhage and the emergency treatment have a great relationship with the prognosis of patients. Generally, the mortality rate is high. Even survivors have the sequelae of hemiplegia or aphasia. Therefore, the key to prevention and treatment of cerebral hemorrhage is to control blood pressure effectively at ordinary times.
How to control morning blood pressure:
1. Regular monitoring of blood pressure
In addition to occasional blood pressure measurement and ambulatory blood pressure monitoring in the clinic, hypertension patients should master the method of family self-test, frequently measure blood pressure, at least once a day after getting up, and timely grasp the early morning blood pressure status.
2. Lifestyle intervention
In order to prevent high blood pressure in the morning, we should pay attention to maintain a healthy lifestyle, such as quitting smoking and limiting alcohol, reducing salt intake, balancing diet, exercising, maintaining weight, eliminating tension, and keeping enough sleep. In terms of sports, we should pay attention to a small amount of activities after getting up in the morning, and never participate in a large number of activities after getting up.
3. Drug cooperation
In the morning, patients with hypertension should use long-acting preparations as much as possible; if medium and short-acting antihypertensive drugs are used, they should take antihypertensive drugs once after waking up in the morning, and then take them once around 2:00 p.m. at night, and should not use them at night; because early morning hypertension is related to the stability of platelets, oral aspirin can not only increase the curative effect of early morning hypertension, but also prevent thrombosis.
4. Causes of hypertension in the elderly
（1） Cause of disease
Part of hypertension in the elderly is the continuation of hypertension in the early stage of the elderly, most of which is due to the degeneration of intima and media of the great arteries, the increase of collagen, elastin, lipid and calcium content, resulting in the decrease of arterial elasticity and compliance. The increase of blood pressure in the elderly is no longer considered as a natural physiological change in the process of aging. The increase of age is not accompanied by a significant increase of blood pressure. Social factors, including environmental factors, diet, mental tension, smoking, obesity, excessive drinking, etc., may cause the increase of blood pressure in the elderly.
（2） Pathogenesis
1. The pathogenesis of hypertension in the elderly is not fully elucidated. At present, it is believed that it is caused by the dysfunction of blood pressure regulation under the influence of various factors.
(1) Regulation of blood pressure: regulation of normal blood pressure is a complex process, which mainly depends on cardiac output and peripheral resistance.
Mean arterial pressure = cardiac output & times; total peripheral resistance
Cardiac output itself is affected by various factors, extracellular fluid volume (changes with sodium intake, renal function, secretion of corticosteroids, etc.), heart rate and myocardial contractility, etc.
Total peripheral resistance is affected by the following factors: alpha; receptor (vasoconstrictor) and beta; Angiotension, catecholamine (vasoconstrictor); prostaglandin, bradykinin (vasodilator).
In addition, there are self-regulation mechanisms, which can play an important role in the regulation of blood pressure and the maintenance of hypertension.
* volume and pressure regulation: when blood pressure drops, sodium and water will retain until blood volume increases and blood pressure rises. If blood pressure rises, sodium and water will increase, reducing blood volume, reducing blood volume and restoring blood pressure.
② The self-regulation mechanism of controlling local blood flow: when the output of blood is increased, the blood pressure is increased, so as to stimulate the baroreceptor, reflexivity causes peripheral blood vessel dilation, myocardial contractility is weakened, so as to prevent the excessive rise of blood pressure. However, the role of baroreceptor gradually disappeared, making arterioles contract instead and peripheral resistance increase. The mechanism of this process is not clear, but it makes local blood flow less. Finally, although the cardiac output has returned to normal, the peripheral resistance still keeps increasing, which makes the blood pressure keep rising.
(2) Atherosclerosis and hypertension in the elderly: at present, many researches and investigations show that atherosclerosis is the most important factor in the pathogenesis of hypertension in the elderly. This is also one of the main differences between the pathogenesis and clinical manifestations of hypertension in the elderly and that in the young. Normal young people have good elasticity, normal arterial wall structure and endothelial function, good coordination of vasodilation and contraction function, and can maintain normal blood pressure level, but the effect of maintaining normal blood pressure gradually loses with the increase of age and arteriosclerosis. The pathological changes of the great arteries in the elderly lead to the rigidity and decrease of the elasticity of the great arteries and the increase of the systolic pressure. In the process of aging, cardiac output remains unchanged or decreased, organ atrophy and cell apoptosis make the peripheral vascular bed sparse, which leads to the increase of peripheral resistance and the increase of mean blood pressure, while arteriosclerosis leads to the increase of pulse pressure. For any individual, if arteriosclerosis is dominant, diastolic blood pressure will be relatively low; otherwise, if peripheral resistance is dominant, diastolic blood pressure will be relatively high. According to statistics, half of patients over 60 years old with hypertension are simple systolic hypertension, which further confirms the important role of arteriosclerosis in the pathogenesis of hypertension in the elderly.