Hypertension is more often observed in older people, because they have more risk factors for its development. Pathology in old age has several features of the course. The same applies to the treatment of hypertension, because most of the elderly have other diseases. The combined use of several drugs can be dangerous to health, so each remedy is carefully selected. Drugs are prescribed from different groups depending on the mechanism of development of hypertension. Herbal medicine also brings a good effect, but it only complements the main treatment.
What is hypertension in the elderly
In medicine, hypertension is a persistent increase in systolic and diastolic blood pressure (BP). This pathology is characteristic of different people, but more often the elderly suffer from it. Hypertension in them is the same disease as in middle-aged people, but has several course features. In addition, aging people are more difficult to treat for high blood pressure. This is due to the characteristics of health in old age. These include the following:
- Vessels are damaged faster due to increased fragility. It is more difficult for them to adapt to sudden changes in pressure, so there is a risk of hemorrhage.
- Atherosclerotic endothelial damage is observed in some patients. This leads to an increase in vascular tone.
- Due to increased rigidity and fragility, the vessels lose their elasticity.
- High blood pressure is often associated with the work of the kidneys and adrenal glands.
Signs of illness
Hypertension in the elderly is a protective reaction of the body, which is necessary for the blood supply to tissues. Due to changes in blood vessels, the heart begins to push blood harder through them, which leads to a decrease in their tone. Against this background, the amount of renin produced by the kidneys, which regulates the pressure level, decreases. Sodium and potassium are more retained in the body. All of these are common causes of increased circulating blood volume and hypertension.
Normally, at the age of 60-70 years, a pressure of 130/80 mm Hg is normal. Art., in 70-80 years - 140/85 mm RT. Art., in 80-90 years - 140/90 mm RT. Art. The diagnosis of hypertension in the elderly is made with an increase in these indicators over 155/95 mm RT. Art. Signs of this disease in the elderly are:
- pain in the neck;
- heart pain;
- throbbing and heaviness in the head;
- noise in ears;
- hand tremor;
- sleep disorder;
- double vision
- increased heart rate;
- swelling of the hands, feet;
- numbness of the limbs;
- shortness of breath during physical exertion, and then at rest.
One of the classifications of hypertension distinguishes several stages of its development. On each of them, high blood pressure has a certain severity, methods of treatment and complications. The list of stages includes:
- First one. It is accompanied by a short-term increase in blood pressure. The condition returns to normal after eliminating the cause of the development of hypertension.
- The second one. In this case, blood pressure rises steadily, so medication is necessary for treatment.
- Third. At the last stage, the development of complications is possible, including dysfunctions of the heart, blood vessels, kidneys, and brain. The elderly have a predominantly benign course of the disease, i.e. long developing. Here you can not do without inpatient treatment.
Hypertension not only worsens the quality of life of elderly patients, but also leads to some dangerous complications on different organs and sometimes even death. The list of consequences of this disease includes:
- myocardial infarction;
- hypertensive encephalopathy;
- heart failure;
- stratified aortic aneurysm;
- renal failure;
- bouts of hypertensive crisis.
For a long time, it was believed that an effective treatment for hypertension for the elderly did not exist. This erroneous opinion was due to the fact that with age, the risk of developing adverse reactions to drugs is high. Then, major scientific studies were carried out, thanks to which it was found that treatment can bring a positive effect. With a properly prescribed treatment regimen, the risk of side effects is minimized.
The main goal of treatment is to improve the quality of life of patients and its extension. It is mandatory to take drugs that reduce blood pressure, but this is not enough. In general, some folk remedies help normalize the condition and cope with hypertension, but they are used as an auxiliary method. Additionally, the patient needs to change his lifestyle:
- It is recommended to walk more in parks;
- it is imperative to exclude smoking and alcoholic beverages;
- avoid stress;
- follow a special diet.
Pressure Cure For The Elderly
The main criterion for choosing a drug is compatibility with other drugs and the absence of many side effects. This is due to the fact that in the majority of the elderly, after examinations, other diseases are found that are also treated with medications. A specific remedy is prescribed only after the tests that are necessary to diagnose the cause of the pathology. Drug therapy has several principles:
- the course of treatment begins with small doses, after which it is gradually increased;
- while taking medication, it is necessary to monitor the work of the kidneys, the balance of electrolytes and water;
- at the age of the patient more than 60 years, treatment may take several months;
- elderly people have a different degree of distribution, absorption and elimination of the drug, so dose adjustment may be required;
- the drug is selected taking into account existing diseases;
- with coronary heart disease, you can not reduce the pressure to normal;
- pressure measurement is carried out in vertical and horizontal positions.
These rules are used in the treatment of any means of hypertension. Drugs are divided into several categories: long or short action, strong and weaker. The main classification of drugs is carried out according to the mechanism of pressure reduction. According to this criterion, the following groups of drugs for hypertension can be distinguished:
- Diuretics. They have a diuretic effect, remove excess fluid from the body, as a result of which the volume of circulating blood decreases and the pressure decreases. Diuretics are preferred for the elderly.
- Antagonists of calcium ions. Inhibit the penetration of this trace element into the cells of blood vessels and the heart. Due to the high level of calcium, there is an increased contraction of these organs, which causes an increase in blood pressure.
- Beta blockers. Eliminate the negative impact of the autonomic nervous system on the heart, weaken the peripheral vascular tone, reduce the need for oxygen. It is prescribed if the patient has ischemia, myocardial infarction or other heart problems.
- Angiotensin-converting enzyme (ACE) inhibitors. Block the specified substance, which stimulates the production of angiotensin, which increases blood pressure.
- Alpha blockers. They bring a good effect in the treatment of men with benign prostatic hyperplasia. Drugs block alpha-adrenergic receptors in the walls of blood vessels, which leads to their expansion and decrease in blood pressure.
The treatment of hypertension in the elderly in the early stages is carried out by diuretics. These are safer and more effective drugs. The action of diuretics is to increase the volume of fluid that is excreted in the urine. As a result, the lumen of the vessels increases, and the swelling of their walls decreases. Among diuretics, the following are often prescribed:
- Hydrochlorothiazide. Named for the same active component in the composition. It has a diuretic property, belongs to the category of drugs of medium strength and duration of action. Indications for use: edema of various origins, hypertension, nephrogenic diabetes mellitus. The dosage is 25-50 mg. For a lasting effect, it must be taken within 3-4 weeks. Hydrochlorothiazide is contraindicated in severe forms of diabetes, anuria, severe renal failure, gout, Addison's disease. The list of side effects is best clarified in the instructions, because they are numerous. Plus, the drug in the rapid development of the effect - after 2 hours.
- Indap. Contains indapamide - vasodilator and diuretic. The therapeutic effect is hypotensive, due to a violation of the reabsorption of sodium ions in the Henle loop. Indap has one indication for use - arterial hypertension. Take the drug orally at 1.25-2.5 mg daily. In the absence of effect, after 4-8 weeks, another medication is added to the treatment. Indap is contraindicated in anuria, hypokalemia, kidney disease, and liver. Adverse reactions are manifested by the digestive, nervous, respiratory, urinary and cardiovascular systems. Plus Indapa - does not affect carbohydrate and lipid metabolism.
Calcium ion antagonists
These drugs for high blood pressure for the elderly relax the blood vessels by reducing the amount of absorbed calcium. In this group, there are both short-term and prolonged action drugs. The second-generation calcium channel blockers are considered the most effective, because they differ in slowing down the release of active substances. Among these, Nifedipine, Dilziatem, Cordaflex and the following drugs stand out:
- Gallopamil. Includes the active component of the same name. It is used for angina pectoris, atrial flutter, arterial hypertension, supraventricular extrasystole, paroxysmal supraventricular tachycardia, myocardial infarction, atrial fibrillation. Dosage is selected individually. After taking, nausea, headache, lethargy, fatigue, and bradycardia may develop. Plus Gallopamil - the development of the effect 1-2 hours after administration. Its contraindications include heart failure, hypotension, cardiogenic shock, liver and kidney failure, aortic stenosis, digitalis intoxication.
- Klentiazem. It is a second-generation calcium antagonist. His predecessor is Dilziatem. Klentiazem is indicated for angina pectoris, arrhythmias, and hypertension. The same component in the composition of the drug has antianginal, antiarrhythmic and hypotensive effects. Contraindications include hypotension, renal failure. The advantage is the increased duration of action. The dosage is 30 mg 3-4 times a day. Adverse reactions should be studied in the detailed instructions for the drug, because they are presented in a large list. The drug Verapamil has a similar effect.
Beta blocker medications are prescribed for patients who have had a heart attack. They are also relevant for chronic constipation, diabetes and cirrhosis. The action of beta-blockers is the inhibition of hormones that reduce the lumen of blood vessels. These drugs are non-selective (Bisoprolol, Metoprolol, Atenolol, Betaxolol) and selective (Anaprilin, Korgard 80, SotaGeksal). Among these medicines, it is possible to distinguish especially effective:
- Atenolol It is named for the active substance, has hypotensive, antianginal and antiarrhythmic properties. Indications for treatment with Atenolol: hypertensive crisis, arterial hypertension, angina pectoris, coronary heart disease, neurocirculatory dystonia, withdrawal syndrome, tremor, agitation. The initial dosage is 25-50 mg. A week later, it is increased by 50 mg. Atenolol is prohibited in severe bradycardia, cardiogenic shock, acute heart failure, cardiomegaly, taking MAO inhibitors, SA blockade. Adverse reactions affect the digestive, respiratory, nervous, cardiovascular systems, sensory organs, and skin integuments. Plus Atenolol - its administration increases the survival of patients after myocardial infarction.
- Propranolol. This is a medication that exhibits antianginal, hypotensive and antiarrhythmic actions. It is used for sinus tachycardia, angina pectoris, supraventricular tachycardia, ventricular extrasystole, essential tremor, arterial hypertension, anxiety, pheochromocytoma. Adverse reactions and contraindications of Propranolol are best clarified in the instructions for it, because they are numerous. The advantage of the drug is in short but quick action. The maximum concentration is achieved after 1.5-2 hours after administration.
Common indications for the use of ACE inhibitors are angina pectoris, diabetes mellitus, myocardial infarction, renal failure, bronchial asthma against a background of high blood pressure. Such drugs for hypertension in old age block the action of the enzyme, which contribute to the conversion of angiotensin to renin. The latter substance causes vasoconstriction, which increases pressure. The described effect is possessed by:
- Captopril. Contains the same substance with antihypertensive effect. Its plus is in quick absorption from the digestive system, so the substance is registered in the blood after 30-90 minutes. Captopril is indicated for malignant hypertension, renal hypertension, and essential and secondary hypertension. With a hypertensive crisis, it is necessary to put a 25 mg tablet under the tongue. The average dosage of captopril for the treatment of hypertension is 12.5 mg 3 times a day. The list of contraindications and adverse reactions includes many items, so they should be studied in the detailed instructions for the medicine. The drug Zokardis has a similar effect.
- Lisinopril. The main component of the composition is lisinopril dihydrate. Its advantage is that it has several actions at once: hypotensive, vasodilating, natriuretic, cardioprotective. The medication is indicated for the treatment of chronic heart failure, arterial hypertension, acute myocardial infarction, and diabetic nephropathy. Take lisinopril once - in the morning at 2.5 mg. The drug has many contraindications and side effects, so before use they should be clarified in the instructions. Enalapril is an analogue, but Lisinopril more effectively reduces pressure and lasts longer.
The use of drugs in this category is gradually stopped, because they have many adverse reactions. The effect of their intake is inhibition of alpha-adrenergic receptors in the walls of blood vessels, due to which the arteries expand and pressure decreases. Clofelin was previously often used in this group, but today it is considered obsolete. Judging by the reviews, the pressure after taking it again rises after a while. The following alpha-blockers are considered more modern:
- Sermion. It contains nicergoline that improves cerebral and peripheral circulation. Additionally, the tool improves hemodynamic and metabolic processes. Sermion is indicated for the treatment of chronic and acute cerebral metabolic and vascular disorders, including arterial hypertension, atherosclerosis, embolism, cerebral thrombosis, vascular dementia. Dosage is determined by the disease.Among the contraindications, marked bradycardia, violation of orthostatic regulation, acute bleeding, myocardial infarction are noted. After taking the pill, insomnia, drowsiness, fever, dizziness, dyspepsia are possible. The advantage of Sermion in the rapid development of the effect. Analogs: Butyroxan, Ditamine - but these drugs are not sold in all pharmacies.
- Urorek. Based on silodozin. The drug is indicated for the treatment of benign prostatic hyperplasia. It reduces irritation, obstruction. The daily dosage is 8 mg 1 time per day. Contraindications include severe liver or kidney failure. Of the adverse reactions, dizziness, orthostatic hypotension, retrograde ejaculation, nausea, diarrhea, and dry mouth are noted. Plus Urorek - it can be combined with many other drugs or used as monotherapy.
Modern medicines for hypertension for the elderly
The difference between new generation drugs is a reduced number of side effects. This is achieved by including several active components in one tool. As a result, their dosage can be reduced, so that the risk of adverse reactions is reduced. In addition, the combined drug allows you to act on several mechanisms for the development of hypertension. The following drugs can be included in the category of “modern drugs for reducing pressure in the elderly”:
- Renipril. Contains enalapril, polyvinylpyridone. The medication exhibits diuretic and antihypertensive effects. Indication for use is arterial hypertension. With a moderate degree, 10 mg / day is prescribed. Renipril is contraindicated in cases of sensitivity to sulfonamides, kidney diseases, liver pathologies, primary hyperaldosteronism, a history of kidney transplantation. Of the adverse reactions, there is a decrease in appetite, dizziness, headache, dyspepsia, pancreatitis, jaundice, photosensitivity, arthritis, hearing or vision impairment. A big plus for Renipril at an affordable price.
- Noliprel. The plus of this medication is its mild effect. The composition of the drug includes indapamide and perindopril. These substances are due to diuretic and ACE inhibitory effects. Noliprel is used for essential hypertension and for the prevention of microvascular complications. Take 1 tablet daily. A single dose is considered an advantage of Noliprel. The remedy is contraindicated in case of kidney and liver failure, hypokalemia, renal artery stenosis, history of angioedema. Negative reactions of Noliprel are manifested in relation to the genitourinary, cardiovascular, respiratory, digestive systems.
The effectiveness of drug therapy also depends on the patient's nutrition. People suffering from hypertension are shown a low-carb diet, which is the prevention of obesity and an increase in cholesterol. For this, potatoes, white flour, sugar are excluded from the diet. The following foods are also prohibited:
- with caffeine;
- bakery and confectionery products;
- fatty meat and fish;
- salty, spicy foods;
- smoked meats;
- canned food;
It is absolutely necessary to limit the use of salt, it is better to completely eliminate it. This will help reduce swelling and lower blood pressure. The following foods are useful for hypertension:
- soups on vegetable and low-fat meat broth;
- stale bread;
- low fat fish;
- lean veal and beef;
- turkey meat, skinless chicken;
- seafood with iodine, including squid, seaweed;
- dairy products with a low fat content;
- chicken eggs;
- leafy greens;
- low-fat cheese;
- dried fruits;
- sweet fruits and berries;
- vegetables - zucchini, Jerusalem artichoke, pumpkin.
Alternative methods of treating hypertension in the elderly
The basis of treatment is only medication. Alternative recipes can be an auxiliary method of therapy. Decoctions, infusions on hawthorn, motherwort and other medicinal herbs are used. Useful for hypertension and vegetable juices, honey, some berries. The following natural remedies are considered effective:
- Grind 2 tsp mountain ash. Gradually pour a glass of boiling water. After half an hour, strain. Drink the drug for 5-6 tablespoons up to 3 times every day.
- Grate beets, squeeze juice out of it. Dilute with water in a ratio of 5: 1. Eat this beetroot juice every morning on an empty stomach.
- Take the zest of one lemon, grate. Add to it 0.5 cups of honey, 1 tbsp. cranberries and half a tablespoon of chopped rose hips. Mix everything. Take the product in the morning and evening for 1 tbsp.
For a patient with hypertension, psychological comfort is important. He needs to avoid depression, conflict, quarrels and other showdowns. The family must try to maintain a friendly atmosphere. Among other measures for the prevention of hypertension are:
- active day with walks in park areas;
- full sleep and rest;
- Wellness gymnastics, discussed with the doctor;
- complete abandonment of alcohol and smoking;
- daily calorie restriction;
- the exception of animal fats, salt, hot spices;
- timely treatment of chronic diseases.