How much blood pressure is appropriate for the elderly (famous doctor lecture hall)
The topic of "higher" or "lower" blood pressure control in the elderly has always been the focus of debate.
There is an old man who is 80 years old this year. He was diagnosed with high blood pressure many years ago, and it has been around 165/100 mmHg. Later, after strict medication and life management, the blood pressure was basically controlled at 130/80 mmHg. However, the children said: "Mother is older, this blood pressure value makes us very worried, it is too low." In fact, the old man's blood pressure is relatively stable, and there is no discomfort such as dizziness, so this blood pressure The level is ideal for her.
There is a popular saying in society: as people age, various body functions are decreasing, so high blood pressure is normal. Modern medicine has proven that high blood pressure will accelerate the occurrence of cardiovascular and cerebrovascular events and aggravate kidney damage, and we have a variety of proven effective methods to control blood pressure and reduce these damages. Therefore, the "high blood pressure" has a range-it cannot exceed 140/90 mmHg, otherwise it will still be treated as high blood pressure.
The elderly are like a machine that has been working for many years. They need constant repair and refueling to extend their working life. If timely measures are taken to effectively lower blood pressure, the incidence and mortality of cardiovascular events can be reduced to a certain extent. Many elderly people have long-term blood pressure maintained at 120-130/70-90 mmHg, and its stability is even better than that of young adults. At the same time, their blood lipids and blood sugar control are also good, and they are full of energy. This shows that the elderly can have the same ideal blood pressure as the young.
Of course, clinically, there are also many elderly people who are weak, or have obvious carotid and cerebral vascular stenosis, and blood pressure control is not effective, so the blood pressure standard (≤150/90 mmHg) can only be relaxed. Considering that the blood pressure is lowered, the long-term benefits will be more. When the patient's blood pressure is stable for a long time and there are no other discomforts, it can be considered to lower the blood pressure a little bit, for example, to 140/90 mmHg. There are also some elderly people who have cardiovascular diseases such as high blood pressure, carotid artery stenosis, and vascular sclerosis from the young and middle ages, especially the poor elasticity of the blood vessels. The blood pressure of these people should not be dropped too quickly or too low, so as not to cause hypotension. Insufficient blood supply to the brain caused by perfusion. Only after the vascular stenosis is resolved by stents and other means, and the condition is stabilized, can we consider continuing to lower blood pressure to delay the progression of carotid plaque and damage to the kidney.
It can be seen that the blood pressure reduction standard for the elderly is not fixed and needs to be determined according to the specific conditions of the patient. The blood pressure control of the elderly can be lower, but it does not mean that the lower the better. "A little lower" means to lower blood pressure appropriately after the controllable range, rather than infinitely lowering blood pressure. There are many patients with high blood pressure after treatment, but the high pressure is up to the standard but the low pressure is low. At this time, it is not recommended to "lower", so as to prevent the heart and other vital organs from being inadequate due to low blood pressure. In short, for the elderly, blood pressure standards are not static and should be treated in specific situations.
(The author is the chief physician of the Department of Cardiology, Beijing Hospital)