January 5, 2021 is the lunar Minor Cold solar term, as the people say: "Minor cold in the two thirty-nine, the cold cold to shake." The whole of China has ushered in a big drop in temperature, and the minimum temperature in Beijing on January 6 is below the record extreme. The lowest temperature of 20 national weather stations in Beijing was all below -18℃, and the lowest temperature of -19.6℃ at the observation platform of the southern suburb of Beijing regional representative station set the lowest value since February 1966. The cold weather will continue for some time to come. In addition to bringing inconvenience to people's outdoor travel, the winter has made patients with hypertension undergo severe tests.

In the afternoon of January 7, the daughter of a 94-year-old grandmother came into the clinic and took out a small book. Said the old lady had high blood pressure for many years, controlled well with antihypertensive drugs, especially It is summer, half a tablet of antihypertensive drugs can control blood pressure normally. However, after entering the winter, especially in the past two days, the blood pressure medicine is added to 1 tablet a day, and the blood pressure is still high. The small book neatly records the blood pressure and pulse of every morning, afternoon and bedtime, and the records show that the systolic blood pressure of the grandmother in recent days is basically 160 ~ 170mmHg. This situation is clearly consistent with the seasonal characteristics of blood pressure fluctuations in hypertensive patients. I adjusted the antihypertensive drug use plan according to the grandmother's blood pressure and pulse. The patient's daughter asked anxiously: "Blood pressure will not drop too low?" . I said, "Your blood pressure is measured very carefully every day, which is very good. After the adjustment of medicine, continue to monitor blood pressure and pulse as now, and strive to control systolic blood pressure below 150mmHg. Come back to the doctor three days later, and decide whether to continue to adjust the medication according to the blood pressure situation."; The patient's family members even said good, with a small book to leave the consulting room.

As a patient with chronic hypertension, this grandmother has several things to do particularly well: 1. Long-term monitoring of blood pressure, pulse, and record in detail; 2. Know how to adjust the use of antihypertensive drugs individually according to blood pressure fluctuations; 3. Monitoring blood pressure fluctuation, blood pressure is not up to standard after adjusting medicine, that is, go to the hospital for consultation; 4. Vigilance for low blood pressure in the elderly during antihypertensive treatment. Why do you say that?

With the increase of age, the elasticity of great arteries decreased and the stiffness of arteries increased. Simple increase of systolic blood pressure and pulse pressure are common in elderly patients with hypertension. In addition, the elderly patients with hypertension were often accompanied by a variety of risk factors and related diseases, and the detection rates of diabetes, hyperlipidemia, coronary heart disease, renal insufficiency and cerebrovascular disease were 39.8%, 51.6%, 52.7%, 19.9% and 48.4%, respectively. Antihypertensive treatment should be more careful and cautious to avoid too low blood pressure resulting in insufficient blood perfusion of target organs resulting in damage to target organs.

According to the characteristics of blood pressure in the elderly, the Chinese Guidelines for the Management of Hypertension in the elderly 2019 put forward several principles that should be followed in the drug treatment of elderly hypertension patients: 1. Small dose: The initial treatment usually uses a small effective therapeutic dose, and gradually increases the dose as needed. 2. Long-acting: Use long-acting drugs with 24-hour continuous antihypertensive effect once a day as much as possible to effectively control blood pressure at night and in the morning. 3. Combination: If the efficacy of single drug treatment is not satisfactory, two or more low-dose antihypertensive drugs can be combined to increase the antihypertensive effect, and a single tablet compound preparation can help improve patient compliance. 4. Moderation: Most elderly patients need combined antihypertensive therapy, including the initial stage, but the initial combination therapy is not recommended for frail elderly and older adults ≥80 years old. 5. Individuation: According to the patient's specific situation, tolerance, personal willingness and economic affordability, choose the appropriate antihypertensive drugs for the patient.

Hypertensive patients aged ≥80 years are called senile hypertension. Antihypertensive therapy in such patients is aimed at maintaining organ function, improving quality of life and reducing overall mortality in the elderly. Systolic blood pressure standards should be emphasized, and under the premise of tolerance, hierarchical and phased treatment programs should be adopted to gradually make blood pressure standards. During treatment, blood pressure, pulse (including orthostatic blood pressure) should be monitored and tolerance assessed. If hypoperfusion symptoms occur, the intensity of treatment should be reduced. Elderly patients with hypertension are recommended to use phased hypertension, blood pressure ≥150/90mmHg, that is, start antihypertensive drug treatment. First, reduce blood pressure to <; 150/90 mmHg; If well tolerated and no symptoms of discomfort, systolic blood pressure can be further reduced to less than 140mmHg.

Author:

Gao Wei

Member of Hypertension Branch of Chinese Geriatric Society

Deputy chief physician of geriatric cardiovascular disease, Second Medical Center, PLA General Hospital

Doctor of geriatric cardiology

(The opinions expressed are solely those of the author. Some pictures in this article are from the Internet, if there is infringement, please contact to delete)