An elderly friend asked Huazi if he had taken antihypertensive drugs and his blood pressure had dropped to 130mmHg, was it necessary to reduce the amount of medication? Because he saw some articles, it was recommended that the blood pressure of the elderly should be controlled above 130mmHg.
Huazi said that in elderly hypertensive patients over the age of 65, the target blood pressure recommended by China's hypertension guidelines is less than 140/90mmHg, which is further reduced to 130/80mmHg if tolerated. Because of concerns that low blood pressure affects blood supply, it is generally not recommended that blood pressure below 130 mmHg be lower. However, some trials have shown that the benefits of strengthening blood pressure control in the elderly may be greater.
First, the characteristics of hypertension in the elderly
Hypertension is an age-related disease, and the older you get, the more people get sick. In china over the age of 75, the prevalence of hypertension is nearly 60%. The characteristics of hypertension in the elderly are different from those of young and middle-aged people, and the control goals and medications are also different.
With aging, the body's aortic arteries gradually harden, compliance decreases, so the main feature of elderly hypertension patients is simple systolic hypertension, that is, elevated hypertension (systolic blood pressure), but low pressure (diastolic blood pressure) is normal or slightly lower, and the pulse pressure between high pressure and low pressure increases.
The international view of the treatment of hypertension is that in older people older than 60 years, systolic blood pressure and pulse pressure are the main indicators of cardiovascular events. The focus of antihypertensive therapy is to control the high pressure standard, reduce the pulse pressure, and ignore the low pressure.
Second, the lower the blood pressure, the greater the benefit
Reducing the blood pressure value of patients with hypertension can prevent lesions of the heart, brain, kidneys, eyes, blood vessels and other organs. However, elderly patients with hypertension often suffer from arteriosclerosis and arterial stenosis at the same time, and there are many comorbidities, so previous studies believe that the control of elderly hypertension patients should not be too strict, and too strict control of blood pressure may do more harm than good.
However, in a multicenter, randomized controlled trial (FEVER study), in patients over 65 years of age, the incidence of stroke and cardiovascular events was reduced by nearly 50% compared with those who controlled high pressure at 145 mmHg.
The control targets for hypertension in the two groups differed by only 6 mmHg, but the results varied significantly, meaning that lower blood pressure values benefited more.
In another multicentre, randomized trial (sprint study), subjects were divided into two groups. One group was the standard antihypertensive group, with a target blood pressure of less than 140 mmHg, and the other group was a reinforced antihypertensive group with a target blood pressure of less than 120 mmHg.
Trials have shown that for every 90 people treated in the intensive antihypertensive group, 1 all-cause death can be reduced, and if only the elderly over 75 years of age are counted, the intensive antihypertensive group can reduce 1 all-cause death for every 50 people treated. The results of the study show that intensive antihypertensive can significantly reduce the risk of death in elderly patients with hypertension.
In one meta-analysis trial (BPLTTC study), the results showed that for every 5 mmHg reduction in systolic blood pressure, cardiovascular risk was reduced by 10%.
Third, the antihypertensive target of elderly patients with hypertension
In previous studies, there are suggestions that the blood pressure of the elderly should not be lower than 130mmHg, and for the elderly, it can be appropriately relaxed to 150mmHg, or even to 160mmHg. But now, based on the results of these trials, a 130mmHg limit may not be set for the antihypertensive target in the elderly.
In elderly hypertensive patients for antihypertensive therapy, the blood pressure is gradually reduced to 150mmHg; if it can be tolerated, it can be further reduced, even if the blood pressure is lower than 130mmHg, but as long as there is no palpitations, dizziness, black vision and other insufficient blood supply, you can maintain the status quo without having to reduce the amount of medicine.
To sum up, with the current study, intensive antihypertensive in the elderly may obtain better disease prevention effects. Even if the blood pressure is below 130 mmHg, as long as it can be tolerated, the treatment can be continued without having to reduce the dose. However, for the elderly with complicated diseases and weak constitutions, individualized treatment is required, and the antihypertensive goal cannot be implemented "one size fits all".
The choice of antihypertensive drugs, as well as the adjustment of the drug, need to be carried out under the guidance of a doctor. If you have any questions about medication, consult your doctor or pharmacist. I am a pharmacist Huazi, welcome to follow me and share more health knowledge.