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Older patients
Hypertension at older patients
The generally valid limits, i.e. classifications also apply to older patients after the latest criterions of the WHO for the hypertonus. I.e. the limit to the manifest hypertonus also lies with senior citizens at 140/90 mmHg. The reduction in increased blood pressure values leads provably the cardiac insufficiency to a life prolongation by reduction of complications of the heart and cerebral vessels as well as from 80 years up to an age. How also at the procedure with younger patients the older also should some weight hypertension be undergone to patients initial of a not medicinal medical treatment (life style modification) to move with the objective sufficiently in a fresh air consume and primarily as well as common table salt consumption bring back to normal alcohol. The effectiveness of these methods is himself however often difficult furred, the putting into action formed also in higher age.
An additional medicinal therapy should always be then considered when the blood pressure values exceed 160/100 mmHg despite not medicinal measures. Is fundamental according to the motto: "Start Low, go slow, " to proceed, i.e. one should start with a monotherapy in a dose power, that one of approximately the half corresponds to the one at younger patients. The dose should be increased or a second antihypertensive added and so the blood pressure lowered depending on exit pressure carefully in intervals of several weeks first. A complete normalization of the blood pressure values should be renounced if < 160/90 mmHg disturbances of the general condition appear at values. Measurements have to be carried out in sitting and in the standing to the blood pressure control to avoid orthostatic blood pressure drops when getting up (danger of collapse, fall and fracture!) In the choice of the medicines it is to look at the glomerular filtration rate of the kidneys reduced in the age generally as well as accompanying illnesses the often multiply available. In addition, the therapy management should be designed as simple as possible and always provided with written instructions due to cognitive problems.
Medicines:
- Diuretika (e.g. furosemide, torasemide, hydrochlorthiacide):
Being used at the most frequent diuretica at older patients which yielded a clear reduction of the cerebrovasculare complications and deaths as well as the cardiac insufficiency as means of the first choice. You are potent and pricewise favorable blood pressure sinkers. It that older people already generally have a reduced fluid photo due to a reduced thirst feeling must be taken into account, however, so that with loss determined (primarily and) blood salts sodium potassium end drying frequently gaining in it by the diuretic effect to one in confusion as well as an increasing qualified sense of the kidney function comes. Therefore Cave and regular controls of electrolytes and kidney function parameters!
- Beta blocker (e.g. metoprolol, bisoprolol):
cardiac insufficiency is and for rather older patients with additional cardialen illnesses reserved, how coronary heart condition, condition after myocardial infarction, tachykarde dysrhythmias (e.g. atrial fibrillation) since the blood pressure is sinking opposite cancelled effect the diuretica something low. It should, however, be checked by regular ECG controls the benefit at the above-mentioned diseases is, however, undisputed to avoid dangerous bradycardias (deceleration of the heart rate).
- Calcium antagonists (e.g. amlodipin, nitrendipin, nifedipin):
aren't superior for the active substances mentioned above and therefore are applied sooner than addition combination means.
- ACE inhibitor (e.g. ramipril, enalapril, captopril):
Are a match for the substances mentioned above. Are due to missing contraindications for example for patients with chronically obstructive lung illnesses, peripheral circulatory disorders U, as well as because of their proved positive influencing mellitus makes sense of cardiac insufficiency, renal insufficiency, remodeling after myocardial infarction and the cardiovascular prognosis at diabetes her use the age. into a great margin possible and sensible.
- AT 1 blocker (e.g. irbesartan, candesartan, lorsartan):
Substitute preparations are practically for patients which don't stand ACE inhibitors so well since they are very similar in their mode of action, however side effect poorer but also more expensive.
- Alpha blocker (e.g. catapressan):
prostate can cause orthostatic blood pressure drops, the cardiovascular complication rate as well as the cardiac insufficiency therefore deteriorate and should just like centrally effective antisympathotonica with the exception of indications provided strictly (e.g. at benign hyperplasia) avoided be
These informations may be considered a substitute for a piece of medical advice in no case. The content of health-illness.com doesn't can and may be put into any case to make diagnoses or carry out self medical treatment independently.
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