Blood pressure management in the elderly and during pregnancy: treatment principles and safety precautions

What principles should be followed in the treatment of hypertension in the elderly?

Elderly patients with hypertension can benefit from antihypertensive treatment. All five major classes of antihypertensive drugs can be effective. Treatment should follow these principles:

(1) Blood pressure should be gradually reduced, especially for those with weaker constitutions.

(2) Attention should be paid to pre-existing and/or post-treatment orthostatic hypotension.

(3) Due to multiple risk factors, target organ damage, and cardiovascular disease, medication selection must be considered in combination.

(4) Multiple drugs are often required.

(5) For patients with benign prostatic hyperplasia, alpha-blockers can be used preferentially.

The target blood pressure is 150/90 mmHg; excessively low diastolic blood pressure may be detrimental to the elderly.

What are the manifestations of gestational hypertension, and what issues should be considered during treatment?

Hypertension occurring during pregnancy is called gestational hypertension. It is characterized by hypertension and proteinuria after 20 weeks of gestation, accompanied by multi-organ damage, with small artery spasm as the pathological basis. Severe cases can lead to convulsions, coma, cerebral hemorrhage, heart failure, placental abruption, and disseminated intraepithelial neoplasia (DIC), even death.

Pregnancy is a very special period for women. To ensure the safety of both mother and child, special care must be taken for the mother, and medications must be used in a way that avoids adverse effects on the fetus.

Preeclampsia refers to hypertension in pregnant women, accompanied by proteinuria and edema.

Hypertension: Blood pressure ≥140/90 mmHg, or blood pressure ≥25/15 mmHg higher than pre-pregnancy or early pregnancy levels, at least twice, with an interval of 6 hours.

Proteinuria: A single urine protein test ≥30 mg, at least twice, with an interval of 6 hours, or a 24-hour urine protein quantification ≥0.3 g.

Edema: Weight gain exceeding 0.5 kg per week is considered latent edema. Edema can be classified according to its severity as follows: (X), localized to the ankle and lower leg; (XX), edema extending to the thigh; (XXX), edema extending to the perineum and abdomen.

Gestational hypertension: hypertension alone, with or without edema, and without proteinuria.

Gestational hypertension often involves the health and safety of both mother and baby. Therefore, once pregnancy is confirmed, regular checkups are necessary for early detection, diagnosis, and treatment. For severe cases, aggressive treatment and timely termination of pregnancy are recommended to reduce maternal and infant complications and mortality.

(1) Treatment for mild cases: Mildly elevated blood pressure, systolic blood pressure <150 mmHg, diastolic blood pressure <100 mmHg, proteinuria <1g/24h, no clinical symptoms, and normal transaminase and platelet counts. Outpatient follow-up observation is recommended. Rest and a balanced diet are important; treatment is generally not required. Follow-up twice a week is necessary. Monitor blood pressure and physical signs. (2) Drug treatment for severe cases: Although the goal of treating hypertension is to reduce the risk to the mother, it is essential to choose effective drugs that are safe for the fetus.

When blood pressure rises above 170/110 mmHg, aggressive blood pressure reduction is necessary to prevent stroke and eclampsia. There is currently no consensus on the appropriate blood pressure level.

(3) Antihypertensive drugs unsuitable for pregnant women: ACEIs may cause fetal growth retardation, oligohydramnios, or neonatal renal failure, and may also cause fetal malformations. Angiotensin II receptor blockers (ARBs): Adverse reactions are the same as ACEIs. Long-term use of beta-blockers may cause fetal growth retardation.