Antihypertensive drugs for the elderly

The elderly are at high risk for high blood pressure and complications caused by high blood pressure. The use of blood pressure medication is essential to improving blood pressure levels and controlling the risk of complications from high blood pressure.

Blood pressure can increase gradually with age, not only that, but the elderly also have many risk factors that make coughing more likely to have high blood pressure, such as obesity, smoking, hyperlipidemia, hyperglycemia. Blood pressure, other chronic diseases, impaired kidney function...
Hypertension is also known as the silent killer because it can cause many complications with unknown clinical manifestations. clear. Elderly people with high blood pressure have a higher risk of heart, kidney, or eye damage or stroke because of many other risk factors.
To be able to diagnose hypertension in the elderly, it is necessary to conduct periodic blood pressure measurements. Once diagnosed, the elderly need to be treated with medication and lifestyle changes.

There are many classes of antihypertensive drugs, each of which may be suitable for a number of different comorbidities, such as the elderly, people with comorbidities...
2.1 Drugs Priority blood pressure treatment for the elderly Diuretics Diuretics are the first-line drug of choice for the elderly without disease, because studies have shown that taking thiazide diuretics reduces the risk of complications on target organs. In addition, the elderly are more likely to experience isolated systolic hypertension, so diuretics should be preferred. Diuretics have the effect of making the body increase the excretion of water and some electrolytes out through the urine, helping to reduce the volume of circulation, reduce the burden on the heart and lower blood pressure. Diuretics commonly used in the treatment of hypertension for the elderly are thiazide diuretics (hypothiazide) that have the effect of removing water and sodium ions from the blood.
Calcium channel blockers Calcium channel blockers are the drug of choice if elderly people with hypertension have reduced renal function but are over 75 years old, because they can reduce the risk of hyperkalemia caused by other groups out. In addition, for black people who do not have kidney disease, this is also the preferred choice to use.
Calcium is necessary for all muscle cell activities, including heart muscle cells and the muscles surrounding blood vessels, the flow of calcium helps to slide the muscle fibers against each other and induce muscle contraction. Calcium channel blockers inhibit the movement of calcium into muscle cells. The decrease in intracellular calcium concentration reduces myocardial contractility and vasoconstriction thereby lowering blood pressure. Some of these drugs that can be used include, Amlodipine , nicardipine, Nimodipine...
ACE inhibitors ACE inhibitors are the drug of choice for elderly people with kidney disease or diabetes, because of research Studies have found that taking this class of drugs reduces the risk of kidney complications in diabetics and slows down the progression of kidney failure. Angiotensin-converting enzyme (ACE) inhibitors work by inhibiting the action of angiotensin-converting enzyme (ACE), which is an important enzyme in converting Angiotensin I to Angiotensin II. Angiotensin II has a very strong vasoconstrictor effect and is involved in water retention, salt retention causing hypertension, this substance plays an important role in essential hypertension. ACE inhibitors work to reduce the production of angiotensin II. As a result, the drug causes blood vessels to avoid constriction, which widens or dilates leading to a drop in blood pressure. Some commonly used drugs in this group include enalapril, perindopril(coversyl), captopril, Lisinopril, Trandolapril...
Angiotensin II receptor antagonists This drug, like an ACE inhibitor, is preferred in people with kidney disease and diabetes, whether elderly or middle-aged.
This is a drug that competes with the Angiotensin II binding site at the AT1 receptor, preventing Angiotensin II from attaching to its receptors to cause vasoconstriction and salt retention causing increased blood pressure. Because the affinity of this drug for the AT1 receptor is many times higher than that of Angiotensin, when binding to that site it does not cause pharmacological effects.
Some commonly used drugs such as Losartan (Cozaar), Telmisartan (Micardis),
Valsartan (Diovan), Irbesartan (Avapro), Eprosartan (Teveten), Candesartan (Atacand) or Azilsartan (Edarbi)...
2.2 drug of choice for high blood pressure In addition to the main drugs of choice above, in some other cases it may be necessary to change the option to option two or three. Here are some second or third options for older people with high blood pressure:
Beta blockers This group of drugs can be used if the elderly have high blood pressure with tachycardia or options above contraindications, side effects...
Beta blockers are drugs that block neurotransmitters such as norepinephrine and epinephrine (adrenaline) from binding to both beta 1 and beta receptors. 2 is present in organs and muscle groups, including muscles around blood vessels, this attachment will cause the effect of narrowing blood vessels, increasing heart rate.
By blocking these substances from binding to its receptors which block the effects of norepinephrine and epinephrine, beta blockers lower blood pressure by dilating blood vessels and reducing heart rate. They can cause a side effect of constricting the airways because beta receptors located in the lungs, if blocked, will cause the muscles surrounding the airways to contract, so they are not used for patients with asthma, COPD .
Some commonly used drugs in this group include: Atenolol (Tenormin), Betaxolol, Bisoprolol fumarate (Zebeta), Carteolol, Carvedilol (Coreg), Metoprolol (Lopressor), Nadolol (Corgard), Penbutolol, Pindolol, Propranolol...
Group aldosterone antagonists Aldosterone is a salt and water retention agent that plays an important role in the progression of kidney disease. Aldosterone receptor antagonists (Spironolactone, eplerenone) may be important in the treatment of elderly patients with renal impairment when blood pressure targets are not achieved with first- and second-choice agents. Aldosterone antagonists have been shown to reduce proteinuria when combined with an ACE inhibitor (ACEI) or an receptor blocker (ARB). Reducing proteinuria has been shown to reduce the risk of cardiovascular events and mortality.
Vasodilators A group of vasodilators that have a direct vasodilating effect, can be chosen if the patient has vascular disease, causing blood vessels to constrict, reducing blood to nourish the organs in the body. .

Usually, the treatment of hypertension in the elderly requires a combination of two drugs to achieve the treatment goal. Consider taking an appropriate combination drug, avoiding the combination of ACE inhibitors and Angiotensin receptor blockers.
Target blood pressure in elderly people with high blood pressure without underlying disease is less than 150/90mmHg according to the new standards, and for elderly people with heart disease or kidney damage, diabetes... pressure is less than 140/90 mmHg.
When taking antihypertensive drugs, especially in the elderly, there is a high risk of orthostatic hypotension. This causes the risk of fainting, dizziness when changing positions. Therefore, to reduce this it is necessary to:
Start with the lowest dose and gradually increase over time depending on the patient's response. Orthostatic blood pressure should be measured to see the patient's blood pressure level to avoid orthostatic hypotension, to select the appropriate dose. The first dose should be taken at night before bedtime. Should not change position suddenly, should get up slowly and step by step to avoid postural hypotension. To control blood pressure, it is best to combine with a suitable lifestyle and diet:
Weight control : Obesity is one of the risk factors for hypertension in the elderly. Take measures such as diet and exercise to control your weight well, maintain a BMI below 23, waist circumference less than 80cm for women and less than 90cm for men. Daily exercise: For the elderly, gentle physical activity brings many benefits. But if you're not fit for physical activity, ask your doctor about exercises you can do. You can do gentle exercise such as walking, short jogging, yoga, nutrition... Healthy diet: The diet should include fruits and vegetables, grains. whole grains and low-fat dairy products. Use fresh foods rather than processed foods. Limit salt intake: Salt is one of many causes of high blood pressure, especially in the elderly. You should limit adding spices to food, learn to read product labels before using. Limit the use of processed foods because there is a lot of salt. Quit smoking: Hypertension and other diseases in the elderly are at high risk if you have a habit of smoking. Therefore, you should give up this bad habit. Quitting smoking not only improves your overall health, but also has a positive impact on lung health...You may need expert help with quitting. Limit alcohol use: No more than 2 drinks per day for men and no more than 1 drink per day for women. Get enough sleep: Sleep disturbance is a common health condition among the elderly. This is harmful to the health of the elderly. So you need to take measures to take care of sleep when needed, reasonable rest time, learn how to manage stress. Because the elderly are at risk for many different medical conditions, taking multiple medications can cause interactions. Check with your doctor to see if medications work together.
Elderly people with high blood pressure are at risk of complications, so most people need to use antihypertensive drugs for the elderly. Note that before taking the drug, it is necessary to examine and evaluate the function of organs in the body.