1ST CITY CLINICAL HOSPITAL

It happens that both the maximum and minimum pressure increases, that is, systolic-diastolic hypertension occurs, and in some cases only the maximum pressure increases (systolic hypertension) or only the minimum pressure (diastolic hypertension). In older people (from 60 to 74 years old), arterial hypertension is extremely common, and they often have both “upper” and “lower” pressure increases at the same time. But in older people (from 75 to 89 years old), only the “upper” pressure often increases, while the “lower” does not change, or even decreases slightly.

Judging by the results of mass (epidemiological) surveys, during which blood pressure is measured once, then in most developed countries arterial hypertension is observed in almost half of older people, and in old people - even more than half. However, the actual number of people suffering from arterial hypertension is somewhat lower, which is proven by repeated examinations of patients.

The fact is that a jump in blood pressure during a single measurement may be due to anxiety associated with a medical examination. This is why a doctor does not diagnose a patient with arterial hypertension based on a single examination. It is interesting to note that in the elderly, as opposed to young and middle-aged people, hypertension is more often observed in women. And one more interesting pattern: in long-livers (90 years and older) blood pressure is usually lower than in elderly and senile people. Epidemiological surveys of the population of different countries of the world have shown that in some tribes leading a primitive lifestyle, blood pressure does not increase with age; among them there are practically no people with arterial hypertension. This feature was noted among the aborigines of Chile, Australia, and Polynesia. To some extent, scientists explain this phenomenon by the fact that they live a measured life and at the same time perform considerable physical activity and eat low-calorie, unsalted food. But as soon as representatives of these tribes leave their native places and live in a modern civilized society, they also often develop hypertension.

Depending on the causes that cause them, doctors divide arterial hypertension into two groups: hypertension and symptomatic hypertension. In the first case, it is an independent disease, in the second, it is a symptom (manifestation) of a disease or some pathological process occurring in the body.

The main causes of hypertension are psycho-emotional overload and hereditary predisposition, which can manifest itself even in old age. Factors contributing to the occurrence of this disease include increased salt consumption and overeating, leading to nutritional obesity. The course of hypertension in elderly and old people is usually benign; at this age there are almost no malignant forms of the disease. And hypertensive crises, manifested by sharp rises in blood pressure and deterioration of well-being, occur less frequently in the elderly and elderly than in middle-aged people.

Of the symptomatic hypertensions (there are more than 50 of them), elderly and old people are especially characterized by sclerotic systolic hypertension, when only the “upper” (systolic) pressure increases. Hypertension is characterized by an increase in both “upper” and “lower” pressure. The cause of sclerotic systolic hypertension is an increase in the rigidity of the walls of the aorta and large arteries, caused by the sclerotic process, in which a diffuse proliferation of harder structures of the vascular walls occurs and a decrease in elastic ones. Sclerotic systolic hypertension is milder than hypertension.

Sclerosis , leading to changes in the structures of the walls of blood vessels, characteristic of the aging of the body, should not be confused with the equally common atherosclerosis, in which the lumen of the arteries is narrowed by atherosclerotic plaques. Most often they affect the arteries of the brain, kidneys, and heart. And hypertension in this case develops in response to a deterioration in the blood supply to these organs.

Symptomatic hypertension in the elderly is often a consequence of chronic pyelonephritis and diabetes. And now the main questions: is arterial hypertension always a disease in an elderly person or is it just a manifestation of the aging of the body? Is it necessary to achieve a reduction in blood pressure numbers? There can be no clear answers to these questions. Hypertension is a disease, and the patient must strictly follow all doctor's orders. Not all elderly and elderly people are recommended by their doctor to take antihypertensive (blood pressure-lowering) medications. And this depends on the form of hypertension, blood pressure values, concomitant diseases, the “experience” of hypertension, and a number of other individual characteristics.

Of course, if a hypertensive crisis has developed, the sharply increased blood pressure must be reduced, and for this you should immediately call an ambulance. But when you feel good, there is no need to lower your blood pressure, since a sharp decrease in blood pressure with large doses of antihypertensive drugs taken at your own discretion can be dangerous for an elderly person. In this case, the blood drains from the brain, and the sclerotic vessels do not have time to quickly react to a sharp drop in blood pressure, and life-threatening collapse may develop. The pressure should be reduced gradually, not necessarily bringing it to normal values. This especially applies to those who have long suffered from hypertension.

As for sclerotic systolic hypertension , it may not affect the well-being of an elderly person. A number of scientists consider this form of hypertension as one of the manifestations of physiological aging of the body. But such hypertension often requires treatment.

For older people, blood pressure up to 160/95 millimeters of mercury is considered normal. However, some older people experience unpleasant sensations (headache, tinnitus, nausea, dizziness) even with lower blood pressure values: Most often this happens to those whose blood pressure has always been low, but in old age it has increased slightly. In these cases, medications are usually prescribed to alleviate the patient's condition.

If arterial hypertension is caused by chronic pyelonephritis, diabetes mellitus or atherosclerosis, then the doctor first takes measures to combat these diseases. Recommends a diet, various medications, and a certain regimen to the patient. And depending on the patient’s condition and well-being, he decides whether it is necessary to lower blood pressure. In some cases, this cannot even be done, unless the pressure, of course, is very high. And the patient should know about this. For example, in a person suffering from pyelonephritis with incipient renal failure, a decrease in blood pressure can further worsen the already impaired process of urine filtration in the renal tubules, where blood must pass under a certain pressure.

SO, IN EACH SPECIFIC CASE, ONLY A DOCTOR SOLVES THE ISSUE. IS IT NEEDED TO REDUCE BLOOD PRESSURE, AND PRESCRIBE THE MEDICATIONS NECESSARY FOR THIS, DETERMINES THEIR DOSE.

But every patient should try not to miss “jumps” in blood pressure and if this happens, call a doctor. Now many people have blood pressure monitors at home. However, it is better not to measure your own blood pressure; let someone at home who is trained in this procedure do it. And for control, you should measure your blood pressure at the clinic about once a month.

For those who do not have a blood pressure monitor at home, I recommend visiting a doctor more often, two to three times a month.

And a few more practical tips. For those older people who have high blood pressure, streamlining their lifestyle and psychological comfort are of great importance. Many things traumatize the psyche of old people: illnesses - their own and those of loved ones, loss of relatives and friends, conflict situations in the family, difficulties in everyday life. The older a person is, the more all this hurts him and, naturally, contributes to an increase in blood pressure. The patient’s relatives and friends must find an opportunity to take care of the elderly person, pay attention to him, support him in difficult times, and encourage him.

It must be said that psychological comfort alone can often reduce blood pressure, and even to a greater extent than antihypertensive drugs. It is difficult to overestimate the importance of physical activity for elderly and old people. But it should not cause severe fatigue. Excessive physical activity is contraindicated! With great caution, we recommend jogging to our patients and warn against heavy loads when performing physical exercises, which are only permissible for trained people. Many people can benefit from participating in health groups.

For arterial hypertension in the elderly, bed rest, unless it is caused by another disease, is indicated only after a hypertensive crisis, and then only for a few hours. Staying in bed is harmful! Elderly people and old people should not get out of bed quickly, especially after a night's sleep. And first of all, this applies to those of them who experience dizziness, as well as those taking antihypertensive drugs.

It is strongly recommended to limit table salt, animal fats and sugar, and eat more unsweetened fruits and vegetables. Eat salads or vinaigrette every day and season them with vegetable oil. Preferably black or gray bread, and oatmeal and buckwheat for cereals. You can include meat, poultry, low-fat fish, protein omelettes, and low-fat dairy products in your diet. The amount of liquid, if there is no swelling or shortness of breath, can not be limited, but it is better not to drink strong tea and coffee.