The unique characteristics of hypertension and the comorbid harms of diabetes in the elderly: treatment benefits and non-pharmacological interventions

23. What are the characteristics of hypertension in the elderly? The incidence of hypertension continues to increase with age. Hypertension in the elderly has its own unique characteristics, mainly manifested in: ① A high prevalence of isolated systolic hypertension (isolated systolic hypertension is defined as systolic blood pressure ≥140 mmHg and diastolic blood pressure <90 mmHg). ② Frequent severe white coat hypertension. ③ Larger blood pressure fluctuations. ④ Prone to orthostatic hypotension, with a 20 mmHg drop in systolic blood pressure being common. ⑤ Increased risk of heart failure. After hypertension is diagnosed in the elderly, those with the means should undergo 24-hour ambulatory blood pressure monitoring to rule out white coat hypertension. Blood pressure should be routinely measured in supine, sitting, and standing positions before diagnosis and treatment decisions. Because diastolic blood pressure peaks around age 55 and then gradually declines, while systolic blood pressure peaks around age 70, the elderly often present with elevated systolic blood pressure, with over 50% exhibiting isolated systolic hypertension and a larger pulse pressure. Isolated systolic hypertension primarily occurs in salt-sensitive elderly individuals, and a low-salt diet can significantly alter blood pressure. Appropriately increasing exercise, reducing weight, lowering cholesterol, and quitting smoking and limiting alcohol consumption are very helpful in improving blood pressure. If lifestyle modifications do not lower blood pressure in the elderly, antihypertensive medications should be selected rationally under the guidance of a doctor. Calcium channel blockers, diuretics, and angiotensin-converting enzyme inhibitors are all suitable for elderly patients with isolated systolic hypertension. With increasing age, the functions of many organs in the body decline and age. The same is true for blood vessels. With increasing age, blood vessels experience decreased elasticity, thickening of the intima, and changes in arteriosclerosis. Simultaneously, the functions of organs related to blood pressure, such as the kidneys, also decline, and the neuroregulatory function tends to decrease... These factors collectively contribute to the characteristics of hypertension in the elderly.

24. Why are diabetic patients prone to hypertension? Careful observers will notice that many people suffer from both hypertension and diabetes. Why is this? This is mainly because diabetes and hypertension share a common pathophysiological basis; diabetes makes it easier to develop hypertension. The probability of developing hypertension in diabetic patients is 1.5 to 2 times higher than in non-diabetic individuals, meaning approximately 50% have hypertension, and the two often coexist. Furthermore, the peak prevalence of hypertension in diabetic patients occurs 10 years earlier than in the general population. Diabetic patients with hypertension are more prone to myocardial infarction, cerebrovascular accidents, peripheral macrovascular and microvascular diseases, and experience accelerated development and progression of retinopathy and kidney failure. The reasons why diabetes easily leads to hypertension may be as follows: High blood sugar makes...

25. Why should patients with hypertension receive treatment? You may have seen people like this around you: high blood pressure, but no symptoms, always looking healthy and radiant, not taking their high blood pressure seriously. When others suggest medication, they argue, "Look at so-and-so, they took medication and had adverse reactions, so I won't take it, it's fine, and it saves money!" However, they don't realize that this approach is too focused on "short-term benefits," and one day they will regret it, thinking, "If only I had known then what I know now!" Many patients believe that since they have no symptoms when their blood pressure is high, they don't need treatment. This view is very harmful. Because antihypertensive treatment is not just about controlling blood pressure within the normal range and alleviating symptoms, but more importantly, reducing the mortality and disability rates from cardiovascular and cerebrovascular diseases, and preventing the occurrence and development of stroke, coronary heart disease, heart failure, and kidney disease. Clinical trial results in my country show that for every 9 mmHg reduction in systolic blood pressure and every 4 mmHg reduction in diastolic blood pressure, the incidence of stroke can be reduced by 36%, the incidence of coronary heart disease by 3%, and the overall cardiovascular events in the population can be reduced by 34%. Clinical trials in Western countries have shown that for every 10-14 mmHg decrease in systolic blood pressure and every 5-6 mmHg decrease in diastolic blood pressure, the risk of stroke decreases by 2/5, and the risk of coronary heart disease decreases by 1/6. While hypertension is an unfortunate condition, early and correct treatment can offer significant benefits and mitigate its effects. As the Chinese proverb says, "It's never too late to mend the fence after the sheep are lost!"

26. Under what circumstances can hypertension be treated without medication? Some patients may find that their blood pressure is higher than the diagnostic criteria and immediately seek medical attention, only to find that the doctor does not prescribe medication. This makes some patients even more anxious. They may be thinking: "Why do others get medication, but I don't? Is it because they don't care about me? Or is my condition special?" In fact, some hypertensive patients can temporarily not take medication. This mainly refers to patients whose blood pressure is on the borderline or only slightly elevated. Their conditions and the methods to improve blood pressure are as follows: (1) Those with high normal blood pressure and no diabetes, target organ damage, or clinically related diseases can first lower their blood pressure by improving their lifestyle. (2) Those with systolic blood pressure between 140 and 160 mmHg and/or diastolic blood pressure between (3) Hypertensive patients with systolic blood pressure exceeding 160 mmHg and/or diastolic blood pressure exceeding 100 mmHg, or hypertensive patients with diabetes, target organ damage, and/or clinically related diseases, should start drug treatment immediately.

27. What are the non-pharmacological treatment measures for hypertension? Many patients with hypertension believe that as long as they take antihypertensive drugs on time and in the correct dosage every day, they can rest easy. In fact, this is also a misconception in the treatment of hypertension. The specific measures of non-pharmacological treatment can be summarized as follows: (1) Weight loss. Reduce calories, maintain a balanced diet, increase exercise, and keep the body mass index at 20-24 kg/m². (3) Reduce dietary fat. Total fat < ​​30% of total calories, saturated fat < ​​10%, increase fresh vegetables to 400-500g per day, fruit to 100g, meat to 50-100g, fish and shrimp to 50g, eggs to 3-4 per week, dairy products to 250g per day, cooking oil to 20-25g per day, and eat less sugar and sweets.