Part 4: Treatment Principles, Characteristics in the Elderly, and Comprehensive Prevention of Hypertension

How to treat hypertension? What issues should be considered?

When you discover that you have high blood pressure, the first thing to do is to determine whether it is primary or secondary.

If it is secondary hypertension, the primary disease should be treated actively. Once the primary disease is cured, blood pressure will return to normal levels. If it is primary hypertension, then blood pressure must be effectively controlled to prevent complications. The following aspects should be noted during treatment:

1. Observe changes in blood pressure to make a definitive diagnosis.

Blood pressure fluctuates greatly in the elderly, so medication should never be prescribed based on a single elevated blood pressure reading.

If possible, blood pressure should be measured multiple times when the patient is calm and well-rested to determine whether antihypertensive medication is needed, and to prevent hypotension and fainting caused by improper medication.

2. Use medication rationally to lower blood pressure

Because the cardiovascular system of the elderly has varying degrees of hardening, the blood vessels become narrower and blood flow decreases accordingly, small doses of milder antihypertensive drugs should be used. Blood pressure changes should be monitored daily for one week to determine the optimal maintenance dose. Avoid using strong antihypertensive drugs to rapidly lower blood pressure, which could lead to insufficient blood supply to the brain and heart, resulting in angina, myocardial infarction, or transient orthostatic hypotension.

For the average elderly person, the blood pressure target is below or around 150/90 mmHg.

In addition, patients with hypertension should avoid taking medications containing ephedrine, such as Fritillaria cirrhosa extract tablets and cough suppressant pills.

This is because ephedrine can raise blood pressure.

3. Continue taking the medication as prescribed; do not stop abruptly.

Once the target blood pressure is achieved, it should be taken at an effective maintenance dose for a long period of time.

It is important to monitor blood pressure changes regularly. Do not stop taking medication abruptly once you feel better, as this can lead to rebound hypertension, or even higher blood pressure than before, and may result in cardiovascular and cerebrovascular emergencies.

If medication needs to be reduced, the dosage should be gradually reduced under the guidance of a doctor.

4. A healthy lifestyle is essential for lowering blood pressure.

A healthy lifestyle is also a non-pharmacological treatment for hypertension. This includes controlling weight, limiting salt intake, getting enough sleep, quitting smoking and limiting alcohol consumption, maintaining a regular sleep schedule, engaging in light exercise, maintaining a good mental state and emotional well-being, avoiding the stimulation of adverse factors, and maintaining a daily bowel movement habit to prevent constipation.

For patients with hypertension, daily salt intake should be controlled between 1.5 and 3 grams.

To prevent loss of appetite caused by salt restriction, eat more fruits and vegetables high in potassium.

Regarding weight, it is generally believed that height (cm) - 105 ± 10% is the normal range for weight (kg), and exceeding the upper limit is considered overweight.

To maintain a normal weight, efforts should be made in two ways: reducing the calories in food and increasing physical activity.

Numerous clinical trials have demonstrated that a reasonable and healthy lifestyle can reduce medication dosage and keep blood pressure at a normal level.

In addition, a person's blood pressure is lowest at night and gradually rises after waking up in the morning and starting to engage in physiological activities.

There have been reports of hypertensive patients suffering strokes while brushing their teeth or urinating in the morning. Therefore, some experts suggest that the first thing hypertensive patients should do upon waking is to take their antihypertensive medication. Since blood pressure is lowest at night and blood flow is slow, it is not recommended to take antihypertensive medication before bed to avoid cerebral thrombosis.

The above are all issues that elderly patients with hypertension should pay attention to when controlling their blood pressure.

Characteristics of hypertension in the elderly

Many elderly people suffer from hypertension, but examinations have revealed that hypertension in people over 60 years old is mainly characterized by elevated systolic blood pressure, while diastolic blood pressure is normal or even below normal.

This is because, with age, the degree of hardening of blood vessels increases, and the elasticity of blood vessels decreases.

Clinically, hypertension in elderly people over 60 years of age with a systolic blood pressure exceeding 160 mmHg (21.3 kPa) and a diastolic blood pressure less than 90 mmHg (12 kPa) is called isolated systolic hypertension in the elderly.

In the past, it was believed that this type of hypertension did not require antihypertensive medication, but recent studies have shown that isolated systolic hypertension in the elderly is more harmful than isolated diastolic hypertension in the elderly.

Because regardless of diastolic blood pressure, the mortality rate from cerebrovascular disease, congestive heart failure, and coronary heart disease increases with rising systolic blood pressure.

Isolated systolic hypertension in the elderly has become one of the most common types of hypertension in the elderly population.

Therefore, once diagnosed, treatment should be initiated promptly. The treatment measures are similar to the general principles of hypertension treatment for the elderly, and are divided into non-drug therapy and drug therapy.

However, it is important to remember that blood pressure should be lowered slowly. When choosing medication, its impact on coexisting diseases should be considered to avoid blood pressure dropping too quickly. Low blood pressure can affect blood flow to vital organs such as the heart, brain, and kidneys, and may induce fatal complications such as myocardial infarction and stroke.

Prevention of hypertension

Hypertension is a common disease among middle-aged and elderly people. It often leads to various serious complications under various adverse factors, and can even be life-threatening, such as cerebral hemorrhage.

Therefore, how to prevent hypertension should be taken seriously by middle-aged and elderly people.

As the saying goes, "Money can't buy you a lean old age."

This means that as people age, they gradually gain weight, and weight gain is harmful to health.

In clinical practice, it is common to see patients with cardiovascular and cerebrovascular diseases who are obese. Therefore, it is essential to lose weight to prevent hypertension.

In addition to controlling your diet, you should also pay attention to walking more and engaging in appropriate exercise to lose weight.

Human activity can increase the level of high-density lipoprotein in the body, which is beneficial for protecting the cardiovascular system.

Elevated levels of high-density lipoprotein (HDL) can prevent atherosclerosis and reduce the incidence of hypertension.

In addition, smoking must be stopped to prevent hypertension, as smoking can cause arteriosclerosis.

The causes of arteriosclerosis are: direct damage to the inner wall of blood vessels; smoking increases serum low-density lipoprotein and very low-density lipoprotein; nicotine in cigarettes can enhance the liver's synthesis of very low-density lipoprotein; and nicotine can inhibit the synthesis of high-density lipoprotein.

Arteriosclerosis causes blood pressure to rise, which can lead to hypertension over time. It is clear that smoking is very harmful to the human body.

Preventing hypertension also starts with preventing hyperlipidemia. It's necessary to adjust your diet and avoid high-animal-fat, high-sugar, high-salt diets, and excessive alcohol consumption. In other words, you must strengthen your self-protection awareness and pay attention to eating scientifically, reasonably, and healthily.

In daily life, blood pressure can suddenly rise when we argue, get angry, get excited, or become emotionally agitated. This shows that changes in emotions have a great impact on blood pressure fluctuations. In order to stabilize blood pressure, we should pay attention to psychological balance and emotional adjustment.

Therefore, it is hoped that middle-aged and elderly people will keep in mind the four principles: reasonable diet; appropriate exercise; quitting smoking and limiting alcohol consumption; and mental health care.

This can effectively prevent the occurrence of hypertension.

To better prevent and treat hypertension, the following suggestions are made:

1. People with normal blood pressure should have their blood pressure measured at least once a year.

2. Patients with borderline hypertension should have their blood pressure measured every 3 months.

3. Patients with hypertension should measure their blood pressure monthly.

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