Treatment of isolated systolic hypertension in old people

Isolated systolic hypertension is a pathology of the cardiovascular system in which the upper, systolic pressure is critically increased, and the lower remains normal. Most often, hypertensive patients see values ​​of 160/90 mm Hg on the tonometer. The risk group includes people of advanced age: the likelihood of hypertension is approaching 30%. The lack of timely therapy can lead to vascular thrombosis, myocardial infarction, stroke, heart failure. To avoid this, you need to know how to treat isolated systolic hypertension in the elderly?

How is ISH treated in the elderly?

The classical treatment regimen is aimed at a two-stage lowering of systolic blood pressure (SBP). Cardiologists recommend undergoing therapy in 2 stages with a number of medicines: thiazides, diuretics, calcium antagonists, ACE inhibitors. During treatment, it is necessary to constantly monitor blood pressure.

The elderly are prescribed the lowest possible dosage at the initial stage of drug therapy. If the patient’s well-being does not deteriorate, then the dosage increases depending on the indicators of systolic pressure. If the drug is ineffective (when the blood pressure does not change), the treatment regimen should be reviewed.

The treatment of isolated hypertension in the elderly has the following tasks:

  • Decrease in blood pressure to the most healthy reference indicators;
  • Prevention of diseases of the cardiovascular system;
  • Reducing the risk of stroke, heart attack;
  • Reducing the risk of mortality, the cause of which is the defeat of internal organs against a background of high blood pressure.

Even 10 years ago, cardiologists did not consider it appropriate to treat ISH in the elderly. The reason is that patients develop a process of rigidity of blood vessels and arteries due to age-related changes. It is difficult and dangerous to treat hypertension in old age, since there is a high risk of side effects after taking medication.

Treatment of patients with modern antihypertensive drugs can reduce the frequency of strokes, complications of the cardiovascular system, as well as reduce coronary mortality in patients.

Patients with ISH aged 60 years and older should be prescribed medication with new generation hypotensive drugs. Thus, the quality of life of hypertension will improve, the prognosis of survival will become more favorable.

The principles of medical treatment of ISH

The first task facing cardiologists is to reduce blood pressure by 30%. It is categorically not recommended to reduce blood pressure by 40 or more units, as the patient has impaired blood circulation, kidney function, and brain failure.

Other principles for the treatment of isolated systolic hypertension in the elderly are:

  • Pressure measurement while lying down, standing. Thus, it is possible to prevent orthostatic hypotension – a sharp decrease in pressure;
  • It is necessary to start taking antihypertensive drugs with the lowest possible dosage. Increasing the dosage of the drug can lead to a sharp deterioration in well-being;
  • The treatment regimen should be simple;
  • It is recommended to combine drug therapy with minor physical exertion, physiotherapeutic methods. By agreement with the doctor, traditional medicine is allowed;
  • Medicines are selected according to an individual scheme, depending on the patient’s history, the presence of other chronic diseases.

When a cardiologist prescribes a treatment model for a patient, it is necessary to take into account the patient’s age and the course of isolated systolic hypertension in the elderly. Why so?

A number of recent studies on the treatment of ISH in the elderly show that they have a therapeutic effect from the prolonged use of antihypertensive drugs than in young, middle-aged patients. The reason is that in the elderly, the degree of renin production in blood plasma is reduced or impaired. But, if you treat with adrenergic receptors and calcium blockers, then the effectiveness will be high.

In older people, jumps in blood pressure are variable, which is difficult in their relief of antihypertensive drugs. Also, there is a violation of the functioning of reflexes in combination with hypotension.

The pace of lowering blood pressure in the elderly

The patient with ISH should know what his initial pressure indicators are and to which marks it is necessary to reduce them. There is a National Committee that evaluates, identifies, holds consultations on the treatment of systolic hypertension. According to them, the optimal amplitude for lowering Blood pressure is no more than 20 units, provided that the initial systolic knowledge was at around 160-180 mm Hg. For example, systolic blood pressure was initially diagnosed in a patient of advanced years as 180 mm Hg, respectively, it is necessary to achieve its reduction to 160 (at the first stage of treatment).

Important! Treatment of isolated systolic hypertension in the elderly consists in lowering blood pressure by 10% (maximum 15%) from the initial value. Decrease in blood pressure up to 30% during therapy is considered critical and even threatening human health and life.

There is a pattern for patients with ISH: if a person does not have a concomitant disease in the form of coronary heart disease (CHD), then the lower the blood pressure, the longer the patient’s life expectancy. But, if the patient is diagnosed with coronary artery disease, then a sharp decrease in pressure to normal healthy values ​​can lead to impaired coronary circulation.

The minimum likelihood of myocardial infarction is present only if the diastolic pressure is maintained at 90 mm Hg.

A sharp decrease in pressure in patients with ISH leads to:

  • Neurological disorders;
  • Cerebrovascular accident;
  • Heart failure;
  • Lethal outcome.

Lowering Blood pressure in hypertensive patients over 60 years of age should pass within a few months. Such an amplitude is considered optimal. Treatment should be carried out with a number of drugs: diuretics, calcium antagonists, angiotensin inhibitors.

Diuretic treatment

Diuretics are prescribed for hypertensive patients with ISH due to their high therapeutic effect, minimal side effects, and adaptability of an elderly person. The initial dosage of the diuretic of the most common hydrochlorothiazide diuretic should be 12,5 ml. Application is shown once a day. If the patient does not tolerate the medication well, then the dosage should be reduced or the schedule should be reduced to a few days a week.

According to world statistics on the treatment of hypertension, diuretics occupy a leading place in effective therapeutic regimens. Drugs have a beneficial effect on the functioning of the cardiovascular system, as well as on the reduction of mortality risks. Diuretics reduce the likelihood of strokes, heart attacks, coronary heart disease.

Hypertensive patients are prescribed drugs: hydrochlorothiazide, indapamide. Other types of drugs today are considered obsolete in terms of their effects on the body and side effects.

Diuretics have a direct effect on blood vessels, increasing the secretion of platelets and prostaglandins. Indapamide is indicated for patients with impaired glucose tolerance, as other types of diuretics provoke this failure.

An effective treatment regimen for ISH with diuretics: low-dose chlortalidone (not more than 12,5 mg / day) in combination with atenolol. As a result of such therapy, the patient decreases the incidence of strokes, heart attacks, vascular diseases, myocardial lesions.

Calcium Antagonist Treatment

Calcium antagonists (AKs) are prescribed to patients for the treatment of isolated systolic hypertension. The drugs are antihypertensive, not affecting the normal indicators of diastolic pressure, without side effects. AK do not change the biochemical parameters of blood, do not disturb the blood flow in the kidneys, do not change the tissue of the left ventricle.

The modern representative of AK is the drug nifedipine. This remedy does not cause tachycardia, headaches, nausea, in contrast to drugs of a similar effect. Derivatives of nifedipine – dihydropyridine. The main difference between this drug and other AKs is the slow release of active dosage forms, their accumulation in tissues, therefore, the patient will need a minimum dosage of the drug. Hypertensive patients are prescribed calcium antagonists in the form of Adalat SL or Procardia XL.

Calcium antagonists are suitable for therapeutic tactics in elderly patients with concomitant diagnoses: diabetes mellitus, heart failure, cardiac asthma, coronary heart disease, blood vessel pathologies. As an initial monotherapy, amlodipine is prescribed in a dosage of 5 mg. First-line AK drugs include: isradipine (dosage 2,5 mg), verapamil (dose 240 mg), nifedipine (dose 30 mg).

Treatment with b-blockers, ACF inhibitors

b-blockers are used as effective antihypertensive drugs as in patients of all ages. The effect of drugs is due to a decrease in myocardial ejection, blockade of adrenergic receptors, a decrease in the production of norepinephrine, a decrease in the flow of venous blood to the myocardium. Before prescribing blockers for a patient older than 60, it is necessary to examine the condition of the kidneys and liver. The treatment regimen for hypertensive ISH includes drugs from the list: proranolol, atenolol, metoprolol, betaxolol in a minimum dosage of 5 mg.

ACF inhibitors are indicated for decreased renin activity. The antihypertensive effect is carried out by suppressing the production of ACF, angiotensin, aldosterone and a simultaneous increase in potassium in the blood plasma. At the same time, the patient does not disrupt the blood flow of vital organs: the brain, kidneys, and parts of the myocar. ACF inhibitors are prescribed for drugs with cerebral encephalopathy, with no side effects. Isolated systolic arterial hypertension in the elderly is treated according to the scheme: captopril (dosage 25 mg), enalapril (dose 5 mg), ramipril (dosage 5 mg), fosinopril (10 mg).

In conclusion, it is worth recalling once again that GIH in the elderly is treated according to the most gentle simple scheme. Therapy begins with the lowest possible dosage of drugs. In the absence of side effects, the dose can be increased. It is not recommended to reduce the patient’s pressure by more than 10-15% of the initial values. A 30% reduction in blood pressure is critical for the elderly with a diagnosis of ISH.

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Tatyana Jakowenko

Editor-in-chief of the Detonic online magazine, cardiologist Yakovenko-Plahotnaya Tatyana. Author of more than 950 scientific articles, including in foreign medical journals. He has been working as a cardiologist in a clinical hospital for over 12 years. He owns modern methods of diagnosis and treatment of cardiovascular diseases and implements them in his professional activities. For example, it uses methods of resuscitation of the heart, decoding of ECG, functional tests, cyclic ergometry and knows echocardiography very well.

For 10 years, she has been an active participant in numerous medical symposia and workshops for doctors - families, therapists and cardiologists. He has many publications on a healthy lifestyle, diagnosis and treatment of heart and vascular diseases.

He regularly monitors new publications of European and American cardiology journals, writes scientific articles, prepares reports at scientific conferences and participates in European cardiology congresses.