Treatment of hypertension at any age should be comprehensive. Recommended:
- Spa treatment;
- proper diet;
- adequate physical activity;
- as well as traditional medicine.
The doctor prescribes the treatment regimen after he has completed all the necessary examinations, gets acquainted with the patient’s history, and also takes into account the general condition of the cardiovascular system.
The following groups of drugs are used to treat hypertension:
- Diuretics. This group of drugs unloads a small circle of blood circulation and dilates blood vessels. These include Hypotheazide, Indap, Arifon, Diuver, Indapamide, Hydrochlorothiazide, Britomar, Ravel. The recommended dose is 25 mg once a day.
- Alpha blockers. Can be used for emergency care. In addition, these drugs stop the growth of tumors, if any. For example, Kapoten, Corinfar, Kordafen. The recommended dose is 25 mg once a day.
- Beta blockers. They do not allow the development of coronary insufficiency, and well dilate the vessels. These include: Atenolol, Timolon, Nebilet, Obzidan, Anaprilin, Metoprolol. The recommended dose is 2 mg once a day.
- ACE inhibitors. They improve the functionality of the central nervous system, normalize brain activity and blood circulation, actively fight against apathy, and prevent renal failure. This group includes: Enalapril, Captopril, Kapoten, Benazepril. The recommended dose is 25 mg once a day.
- Calcium antagonists. They help improve blood flow, prevent the development of strokes and heart attacks. Examples: Nifedipine, Verapamil Retard, Bisaprol.
- Neurotropic drugs. The functioning of the peripheral nervous system is normalized: Dopegitis, Clonidine, Guangfacin.
- Angiotensin blockers. Prevent vasoconstriction: Cozaar, Losartan.
Properly selected antihypertensive therapy reduces the risk of death from all causes by 13%, including:
- from cardiovascular diseases – by 18%;
- from complications of cardiovascular diseases – by 23%;
- from a stroke – by 30%;
- from myocardial infarction – by 23%.
Such figures were demonstrated by a large foreign study, in which 15,7 million patients took part. They were observed on average 3,8 years.
Hypertension can be started at home. The first thing to do is change your lifestyle:
- limit salt intake to 3 g per day (ideally, exclude altogether, replacing with spices);
- reduce coffee and tea intake – no more than 2 cups of these soft drinks per day. Concerning the effect of coffee on pressure, a lot of research was carried out, which made it possible to establish just such numbers;
- turn on
- be sure to move – at least 30 minutes a day;
- monitor your own weight.
Let’s talk about everything in more detail. An elderly person must eat varied food (do not forget about the syndrome Hypertension (GB) belongs to the group of diseases requiring lifelong treatment. High blood pressure (BP) is recorded in 50-70% of young people.
More attention should be paid to PA pressure – pulse pressure (the difference between blood pressure and DBP). The increase in this indicator is more than 50 mm RT. Art. indicates an increase in stiffness of the arterial wall. Such vessels interfere with the normal blood flow and provoke the development of left ventricular hypertrophy, coronary circulatory failure, ischemic brain damage and drug resistance.
A gradual increase in blood pressure during stabilization or decrease in blood pressure arterial pressure occurs with increasing duration of hypertension, changing its hemodynamic structure, and acquires the features of isolated systolic hypertension (ISH).
Factors affecting the course of hypertension in old age:
- dysfunction of baroreceptors, sympathetic regulation;
- renal dysfunction;
- the work of the renin-angiotensinaldosterone system (RAAS);
- disruptions in the axis of the hypothalamus – pituitary gland – adrenal cortex;
- pronounced structural changes in the aorta and its main branches;
- violation of metabolic processes.
GB in the elderly is characterized by a number of features:
- The high frequency of “pseudo-hypertension” is a mismatch of the measured intra-arterial pressure measured by the Korotkov method. As a result of sclerotic processes in the vessels, blood pressure indicators obtained using a tonometer do not coincide with the actual ones, which serves as the basis for the appointment of untimely treatment.
- High lability of blood pressure. It significantly worsens the quality of life, forcing the patient to constantly expect an increase or decrease in indicators, violates the regimen of taking antihypertensive drugs, and reduces confidence in the doctor and the treatment prescribed by him. Patients with high lability. Blood pressure is much worse tolerate a decrease in pressure, accompanied by cardiocerebral syndrome (dizziness, headaches, drowsiness, palpitations, unsteady gait).
- Hypersensitivity to salt. With age, renin activity gradually decreases. This leads to a good result in the treatment of hypertension with diuretics.
- Changes in the autonomic regulation of cardiac activity. Myocardial sensitivity to adrenaline increases, which causes the development of rhythm disturbances, ischemic heart damage in response, even with slight excitement or physical stress.
The quantity and sensitivity of β decreases with age2-adrenoreceptors, which causes an imbalance between the lumen of the vessel in the form of narrowing or dilatation towards spasm. Over time, autoregulation of cerebral, renal, and coronary circulation changes. This leads to an increase in vascular resistance and a decrease in sensitivity to antihypertensive tablets.
Sclerotic processes in the cerebral arteries, narrowing of their diameter and tightening of the walls lead to poor adaptation of cerebral hemodynamics to reduced blood pressure. Age-related patients develop hypertensive dementia (atrophy of the subcortical white matter) and increase the risk of stroke. Additionally, the prognosis worsens atherosclerosis of the carotid arteries, osteochondrosis of the cervical spine.
Renal damage in hypertension progresses slowly and imperceptibly. Only in the later stages are clinical symptoms manifested, when it becomes much harder to correct the disorder.
Enhanced activation of RAAS leads to hypertrophy of the muscle layer of the arterial wall, the proliferation of connective tissue. As a result, atrophy of the renal tubules occurs, which is manifested by a high level of creatinine, serum urea and symptoms of chronic renal failure (CRF).
Therefore, for elderly patients before starting hypertension therapy should determine:
- protein in the urine;
- glomerular filtration rate (GFR);
- plasma concentration of creatinine and urea.
Today it has become clear that the frequency of arterial hypertension (a synonym for hypertension) increases with age. So, already 90% of 55-year-old people with normal blood pressure will subsequently increase it. And if in 60 years the pressure is higher than 139/89 mm Hg. is registered in 45% of all people, in the period from 60 to 80 years this figure is already 60%, and after 80 years it tends to 80%.
The upper (systolic) pressure rises by about 3-6 mm Hg per year. The lower (diastolic) pressure rises to 55-60 years, after which it begins to decline.
Hypertension in old age increases mortality by 2-5 times, including from cardiovascular catastrophes – by 2-3 times. And the higher the figure of “upper” pressure rises, the higher this risk.
Use of drugs Cardiline, Detonic
In the treatment of elderly patients with hypertension, it is optimal to adhere to the low-dose strategy, since due to age-related regulatory imbalance, the frequency of orthostatic hypotension increases.
Excessive decrease in blood pressure in patients of this group causes ischemia of the brain with the development of neurological deficits and mental disorders.
A mild decrease in blood pressure makes it possible to gradually resume the functional state of the vessels.
The basic principles of treatment of elderly patients with hypertension:
- Start with non-drug methods (weight loss, nutrition, physical activity).
- Treatment should be selected taking into account concomitant diseases.
- The optimal pressure level is considered the lowest blood pressure, which the patient tolerates well.
- Medicines must be selected individually, starting with the minimum doses, with constant monitoring of clinical indicators (cerebral blood flow, ECG, GFR).
- Adequate treatment requires a combination of two or more drugs from different groups with several pathways of metabolism and excretion.
Traditionally, first-line drugs in such patients are diuretics and calcium antagonists (especially with ISH). ACE inhibitors and sartans also show high efficacy.
The choice of medication to lower blood pressure in the elderly depends on:
- Risk factors:
- Blood lipid spectrum.
- Family story.
- Degrees of damage to target organs:
- Cerebrovascular disease.
- Angina pectoris.
- Myocardial infarction.
- Congestive Heart Failure (CHF).
|Class of drugs||Показания||It is undesirable to apply|
|Loop diuretics||CRF, CHF||Hypokalemia associated with arrhythmia|
|Thiazide diuretic||CHF, ISH||Gout, SKF lt; 30 ml / min.|
|Aldosterone Antagonists (AA)||CHF, cardiac cirrhosis, post-infarction cardiosclerosis, atrial fibrillation||Chronic renal failure, hyperkalemia|
|β-blockers (BB)||Angina pectoris, post-infarction cardiosclerosis, tachyarrhythmias, CHF||Asthma, AV block II-III Art.|
|Calcium Antagonists (AK)||GHI, angina pectoris, vascular disease of the lower extremities, atherosclerosis of the carotid and renal arteries||Tachyarrhythmias, CHF|
|Calcium Channel Blockers (BCC)||Angina pectoris, supraventricular tachycardia, carotid arteriosclerosis||AV block II-III art., CHF|
|ACE Inhibitors||CHF, left ventricular dysfunction, postinfarction cardiosclerosis, nephropathy in diabetes and hypertension||Hyperkalemia, bilateral renal artery stenosis|
|Angiotensin II Receptor Antagonists (Sartans) (ARA)||The same as for ACE inhibitors, and cough caused by taking ACE inhibitors||Same as for ACE inhibitors|
|α-blockers (AB)||Benign prostatic hyperplasia, hypercholesterolemia||Orthostatic hypotension, CHF|
|Medication class||Name||Доза||Multiplicity of application|
|Loop diuretics||Furosemide||20-40 mg||1 r / d|
|Trifas Cor||5 mg||1 r / d|
|Diuver||5 mg||1 r / d|
|Britomar||5 mg||1 r / d|
|Thiazide diuretics||“Hydrochlorothiazide”||12,5-50 mg||1 r / d|
|Hypothiazide||12,5-50 mg||1 r / d|
|Indapamide||2,5 mg||1 r / d|
|Combined||“Diuretidine”||1 table.||1 r / d|
|“Moduretic”||1 table.||1 r / d|
|Aldosterone Antagonists||Veroshpiron||25-50 mg||1-2 r / d|
|“Spironolactone”||25-50 mg||1-2 r / d|
|Eplerenone||25 mg||1-2 r / d|
|α-blockers||“Doxazosin”||1 mg||1 r / d|
|β-blockers||Anaprilin||80 mg||2 r / d|
|Atenolol||50 mg||1-2 r / d|
|Bisoprolol||Titration from 2,5 mg to the optimal dose||1 r / d|
|Concor||2,5-5 mg||1 r / d|
|“Metoprolol”||50 mg||2 r / d|
|“Nebilet”||2,5-5 mg||1 r / d|
|Calcium antagonists||Amlodipine||5-10 mg||1 r / d|
|Corinfar||10 mg||2 r / d|
|“Lerkamen”||10 mg||1 r / d|
|Nifedipine||10 mg||2 r / d|
|Norvask||5 mg||1 r / d|
|Calcium channel blockers||Verapamil||40-80 mg||3 r / d|
|Diltiazem||60 mg||2 r / d|
|ACE Inhibitors||Burlipril||5-10 mg||1 r / d|
|Captopril||6,25-12,5 mg||2 r / d|
|Lisinopril||5-10 mg||1 r / d|
|Prestarium||4 mg||1 r / d|
|Perindopril||4 mg||1 r / d|
|Noliprel||2-4 mg||1 r / d|
|Ramipril||1,25-2,5 mg||1 r / d|
|Enalapril “||5-10 mg||1 r / d|
|Angiotensin II Antagonists (Sartans)||Vasar||80-160 mg||1 r / d|
|“Valsacor”, “Diocore”||80-160 mg||1 r / d|
|Lorista, Cozaar, Lozap||25-50 mg||1 r / d|
If blood pressure cannot be controlled by a combination of three drugs of different classes, then we are talking about a resistant form of hypertension.
Poor control of blood pressure contribute to:
Arterial hypertension is triggered by a frequent increase in blood pressure.
The circulatory system is a system of blood vessels, veins, capillaries and arteries. Over time, against the background of the adverse effects of the external environment, its functioning is disrupted. This leads to blockage of blood vessels, their patency is getting worse.
Hypertension is caused by often increasing blood pressure. The vessels of a sick person are stretched, damaged, weakened.
The table shows the main complications of hypertension in the elderly.
|Impairment of attention||89|
|Decreased visual acuity||67|
Until the 80s of the 20th century, it was believed that in order to function normally in an elderly person, vital organs (such as the brain, heart, and kidneys) require an increase in blood pressure. This theory was confirmed: when the old man’s blood pressure sharply decreased, his kidney function worsened, unstable angina (fraught with the development of a heart attack) arose, and transient ischemic attacks (micro-strokes) appeared. But over the years that followed, science has advanced dramatically, and new data have appeared in medicine.
It turned out that age itself leads to the development of hypertension. The older a person becomes, the stiffer the wall of his large and medium arteries become – those vessels that “form” blood pressure. It turns out that under the pressure of the blood pushed out of the heart, they relax worse and worse, squeezing a column of liquid (blood). This damages the pressure-sensing receptors in the arteries – and they only respond to higher pressure.
Arteries that become stiffer and less extensible give the blood that they push into smaller vessels a higher speed. Reducing, the ventricles of the heart stretch the wall of the largest artery – the aorta, causing a wave to appear here. The wave travels down all the arteries, reaches the capillaries and is reflected from them, returning to the aorta in the form of echo waves.
With age, the work of the autonomous nervous system also changes – the one that controls the work of internal organs (it consists of the sympathetic and parasympathetic parts). The ratio between the receptors for adrenaline and norepinephrine changes, which react differently to these substances. So, it becomes more than those that will increase the amount of blood ejected by the heart and narrow the vessels, and less than those that improve the conduction of the impulse along the myocardium, expand the bronchi and arteries. In addition, with age, the level of adrenaline, norepinephrine and dopamine in the blood increases; to 70 years – twice.
With age, the balance of various substances circulating in the blood, which affect the tone of blood vessels, changes. So, the number of factors relaxing the vessels (NO, prostacyclin) decreases, and the substances that compress the arteries, on the contrary, increase (this is endothelin-1, thromboxane A2). It is the latter molecules that exacerbate the severity of arterial hypertension, and also lead to the fact that the arteries are not able to restore their original shape.
In people older than 60 years, changes occur in the kidneys:
- the number of main working units – nephrons decreases;
- the number of cells that produce the kidney hormone – renin decreases;
- the concentration of a hormone-like substance – a natriuretic peptide increases, the task of which is to remove sodium and water through the kidneys with increasing pressure;
- replacement of normal connective kidney tissue (similar to cicatricial) progresses;
- small renal arteries are gradually overgrown with connective tissue, that is, they cease to function.
In addition to the indicated causes specific to age, the causes of hypertension in people over 60 years old can be diseases (including those of a tumor origin):
Frequent strong emotions (both positive and negative), overweight, bad habits, excessive consumption of salt can also provoke hypertension.
In old age, not only “normal” hypertension occurs. People over 60 years of age have a special behavior of blood vessels:
- there may be pseudohypertension, when the pressure is higher in the brachial artery, due to the age-related thickening of its wall. In general, blood pressure is within normal limits;
- blood pressure may increase in response to the presence of a medical professional – “white coat hypertension”;
- pressure may decrease after eating: therefore, it is not worth measuring at this time;
- pressure decreases after rising. Therefore, European societies – hypertonic and cardiological – recommend measuring the pressure in the elderly in an upright position.
If an increase in blood pressure was first recorded in old age, it is first of all necessary to exclude precisely internal diseases: damage to the kidneys and renal vessels, hypothyroidism (decreased production of thyroid hormones).
It is recommended to do this with a mechanical tonometer – one that you need to pump yourself and let the air out of the cuff. Ideally, an outsider should do this, but if this is not possible, then it’s best to do this:
- ask for the first time to measure the pressure with a hand tonometer of a doctor, nurse or relative;
- the first measurement should be performed in the supine position 2 times: the first time to determine the figure with the “ears” – using a phonendoscope, the second time – putting your fingers on the radial artery to mark the moment when it began to pulsate;
- the figures received for the first time do not need to be said to an elderly person: this will prevent the excitement from which blood pressure will immediately rise;
- Having measured blood pressure 2 times, it is necessary to note its “upper” numbers. If it matches with “ears” and “fingers”, an elderly person can safely buy a good automatic blood pressure monitor, which requires only one press of a button, so that he himself begins to measure. When choosing, you will need to compare the readings on a manual tonometer and on an automatic one and acquire one that will show the same numbers;
- if between the numbers obtained by listening and feeling the pulse is more than 15 mm, you need to contact a cardiologist to measure the pressure by an invasive method (with the introduction of a needle into the artery). Only after understanding the error between the measurement of pressure by a mechanical and invasive tonometer, you can buy a parent automatic or semi-automatic device for tonometry.
What to look for when taking medication?
Arterial hypertension in an older person is not only an increase in blood pressure, but also resistance of the walls of arterioles, narrowing of their lumen, endothelial damage with almost irreversible changes in its structure.
“Aggressive” decrease in blood pressure to the target level leads to a number of side effects:
- precariousness, lack of confidence in the gait;
- general weakness;
- feeling of lack of air.
These phenomena significantly reduce patient adherence to treatment.
A cure for pressure for the elderly should combine several qualities: high efficiency at minimum doses, a mild decrease in blood pressure, a small number of contraindications, ease of use and affordable price. A new generation of foreign drugs meets these criteria, but unfortunately they are more expensive compared to domestic counterparts.
High pressure pills for elderly patients are selected taking into account the accompanying diseases.
|Concomitant pathology||Recommended||Restrict use|
|CHF||Diuretics, ACE inhibitors, sartans, BB (with slow selection of a dose)||AA, AK, Hydralazine|
|CHD||BB, AK, ACE inhibitors, sartans||Hydralazine AA|
|Impaired cerebral blood flow||Diuretics, ACE inhibitors, sartans, dihydropyridine AK||“Reserpine”, “Dopegit”, “Clonidine”|
|CRF||Loop diuretics, AK, Dopegit||Thiazide diuretics, AA. Use ACE inhibitors and sartans carefully (control of GFR)|
|COPD||Diuretics, AK, Sartans||With caution – BB. ACE inhibitors sometimes cause coughing.|
|Gout||IAPF, Sartans, AK||Diuretics|
|Albuminuria, proteinuria||ACE inhibitors, sartans, AK, Moxonidine, Urapidil||BB, thiazide diuretics, “Clonidine”|
|Diabetes||Sartans, ACE inhibitors, AK, Moxonidine, Urapidil||BB, thiazide diuretics, “Clonidine”|
|Peptic ulcer and duodenal ulcer||Diuretics, Sartans, ACE inhibitors||Reserpine, BB|
Elderly patients for adequate control of Blood pressure are forced to take a regimen of two, three or even four antihypertensive drugs.
Therefore, several recommendations for the use of drugs should be observed:
- At the doctor’s appointment, tell about all the pills you take.
Some drugs weaken the effect of antihypertensive drugs (non-steroidal anti-inflammatory, vasoconstrictive drops in the nose, corticosteroids, herbal medicine).
- On a separate sheet, write the entire list of medicines that you need to take every day, and keep it in a conspicuous place.
- Leave a pill reminder on your mobile phone.
- Keep a diary of blood pressure. Measure blood pressure two to three times a day at the same time. These notes will help the doctor select the optimal treatment regimen.
- Before using each, read the instructions. Pay special attention to the side effects and symptoms of an overdose.
- It is optimal to divide the medicine into two doses (in the morning and before bedtime). This contributes to 24-hour blood pressure monitoring, especially during dangerous night hours.
- Take medication systematically. If time is missed, do not double the dose.
- Do not replace drugs on their own, their dosage and frequency of use.
- If side effects occur, consult a doctor immediately.
- Regularly undergo a medical examination. Monitor heart, liver, and kidney function.
Symptoms requiring medical attention:
- sharp decrease Blood pressure with nausea, dizziness, darkening in the eyes;
- pain in the pericardial region, shortness of breath;
- the appearance of arrhythmia, tachycardia;
- sharp deterioration in sight;
- swelling of the legs;
- decrease in the amount of urine;
- dry obsessive cough;
- subcutaneous hemorrhage, nosebleeds;
- allergic rash;
- nausea of abdominal pain, discoloration of the stool.
To achieve the best effect, hypertensive patients are recommended to use non-drug methods of treatment:
- eat ration, reduce weight;
- limit the amount of salt;
- stay a lot in the fresh air, walk, do morning exercises;
- exclude alcohol, tobacco and caffeine;
- minimize stress.
Symptoms of advanced hypertension
The following symptoms indicate an increase in pressure in an elderly person:
- pain in the heart;
- noise in ears.
The danger is that such symptoms in a person “over 60” can appear only with a significant – above 200 mm Hg – increase in blood pressure. And at some time, a stroke or a myocardial infarction, supposedly against the background of complete health, may develop – after all, an elderly person had no idea about the existence of hypertension.
Features of hypertension at a given age
Elderly people often suffer from hypertension, as they have more risk factors for its development. The fact is that with age, blood vessels become more fragile, which means they are prone to damage. Thin vessels are more difficult to adapt to sudden changes in blood pressure and the risk of hemorrhage increases.
Also, elderly people have atherosclerotic lesions of the endothelium and vascular tone increases. In addition to the fact that over the years, blood vessels lose their elasticity, blood pressure can increase due to impaired functionality of the kidneys or adrenal glands.
By old age, a person is already acquiring chronic pathologies, so the treatment of hypertension should be careful, taking into account other diseases. Just reducing the pressure is not enough, you need to ensure the proper functioning of the internal organs. As a rule, under the blow of the kidneys, brain, heart, stomach, organs of vision. Therefore, it is important that drugs that lower blood pressure do not affect their work.
To reduce the risk of developing hypertension in the elderly, it is recommended:
- daily walk in the fresh air;
- by permission of the doctor, perform morning exercises;
- stop drinking alcohol and quit smoking;
- monitor weight, sugar and cholesterol in the blood;
- sleep at least 8 hours at night and be sure to relax during the day;
- avoid conflicts and stress;
- regularly undergo examinations by a cardiologist and follow all the doctor’s instructions.
The treatment of hypertension in the elderly is long and systemic. The patient is required diligence and self-discipline. New generation drugs have already proven their effectiveness even for patients of advanced age, therefore, after consulting a doctor, it is necessary to adhere to the treatment regimen prescribed by him.
Detonic – a unique medicine that helps fight hypertension at all stages of its development.
The complex effect of plant components of the drug Detonic on the walls of blood vessels and the autonomic nervous system contribute to a rapid decrease in blood pressure. In addition, this drug prevents the development of atherosclerosis, thanks to the unique components that are involved in the synthesis of lecithin, an amino acid that regulates cholesterol metabolism and prevents the formation of atherosclerotic plaques.
Detonic not addictive and withdrawal syndrome, since all components of the product are natural.
Detailed information about Detonic is located on the manufacturer’s page.
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