Characteristics of hypertension in the elderly and traditional Chinese medicine treatments
> 3.11 // What are the characteristics of hypertension in the elderly?
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It is well known that blood pressure gradually increases with age, and two-thirds of people over 65 years of age suffer from hypertension.
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Data shows that even if blood pressure is normal, there is a 50% chance that people over 55 years old will develop hypertension.
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Blood pressure fluctuates greatly in the elderly and is easily affected by the environment, posture, and emotions.
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As various organs age, the sensitivity of blood vessel baroreceptors in the elderly decreases, leading to greater fluctuations in blood pressure, especially in systolic blood pressure.
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Orthostatic hypotension occurs more frequently in the elderly, especially when taking alpha-blockers in antihypertensive treatment. This is also related to the reduced barosensory function in the elderly. Therefore, when taking antihypertensive drugs in the elderly, it is essential to start with a small dose and gradually increase the dose or type to gradually achieve target blood pressure.
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The normal 24-hour blood pressure variation in healthy individuals is characterized by daytime blood pressure peaking between 8-10 AM and 4 PM, followed by nighttime blood pressure decline, exhibiting a biphasic-trough, long-handled dipper pattern. Generally, nighttime blood pressure levels are more than 10% lower than daytime levels. However, in elderly hypertensive patients, the nighttime blood pressure decline is smaller, the dipper pattern is less pronounced, or even disappears. Some individuals even experience nocturnal hypertension. This loss of the diurnal rhythm of blood pressure, coupled with persistently elevated nighttime blood pressure, puts the cardiovascular system under prolonged high-load conditions. This is also why hypertension in the elderly can easily lead to and exacerbate damage to vital organs such as the heart, kidneys, and brain.
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For older adults, the higher the blood pressure, the greater the likelihood of myocardial infarction, heart failure, stroke, and renal insufficiency. For older adults with blood pressure between 115/75 mmHg and 185/115 mmHg, the risk of cardiovascular disease doubles for every 20 mmHg increase in systolic blood pressure.
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Isolated systolic hypertension refers to hypertension with a systolic blood pressure greater than or equal to 140 mmHg and a diastolic blood pressure less than 90 mmHg. 90% of isolated systolic hypertension occurs in people over 60 years of age, hence it is also called elderly systolic hypertension. The incidence of systolic hypertension in people over 60 years of age is 7.13%, accounting for 57% of hypertension in elderly men and 65% of hypertension in elderly women.
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The main reasons for systolic hypertension in the elderly are reduced elasticity of the cardiovascular system, arteriosclerosis, and the direct transmission of pressure to peripheral blood vessels during cardiac contraction, lacking the elastic buffering of large arteries.
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Among people with hypertension under the age of 60, isolated systolic hypertension accounts for only 5%, while those aged 60-70 account for 10%, and those over 70 account for 24%.
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Because only systolic blood pressure is elevated while diastolic blood pressure is not, the pulse pressure difference (pulse pressure = systolic blood pressure - diastolic blood pressure) increases. The larger the pulse pressure, the more likely it is to cause damage to vital organs such as the heart, kidneys, and brain. In addition, elderly people often have a long history of hypertension, so hypertension in the elderly is often accompanied by damage to vital organs such as the heart, kidneys, and brain.
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Because elderly people have reduced kidney function and slower drug metabolism, and because hypertension in the elderly is often accompanied by renal artery sclerosis, their kidneys have reduced ability to metabolize drugs and toxins, resulting in poor tolerance to antihypertensive drugs. High doses of antihypertensive drugs can easily accumulate in the body, increasing the toxic side effects of the drugs. Therefore, elderly people should start taking medication with a small dose, and sometimes a small dose can relieve the symptoms of hypertension.
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Alzheimer's disease is also closely related to hypertension. Good blood pressure control can not only prevent damage to important organs such as the heart, kidneys, and brain, but also slow down the progression of Alzheimer's disease. However, when taking antihypertensive drugs, central nervous system antihypertensive drugs such as clonidine and methyldopa should be avoided to prevent and reduce the occurrence of depression.
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> **3.12//Traditional Chinese Medicine Remedies for Hypertension**
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> (Prescription 1) Bupleurum 6-10g, Pueraria lobata and Salvia miltiorrhiza 10-15g each, Chrysanthemum and Morus alba 12-15g each, Paeonia suffruticosa, Paeonia lactiflora, Carthamus tinctorius and Pheretima aspergillum 10-12g each, Mentha haplocalyx 6g.
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> Modifications: For those with obvious blood stasis, add Pangolin scales, Sparganium rhizome, and Curcuma rhizome; for those with obvious heat symptoms, add Scutellaria baicalensis; for those with constipation, add rhubarb; for those with severe headache, add [unclear text].
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> Vitex trifolia; for those with edema, add Leonurus japonicus and Lycopus lucidus; for those with phlegm, add Bambusa textilis, bamboo sap, and Arisaema cum bile.
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After the treatment was effective and the blood pressure decreased, the herbs *Bohe*, *Chaihu*, *Dilong*, and *Honghua* were removed from the prescription.
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Usage: Decoction of the above-mentioned herbs, divided into two doses, one dose per day, for 30 consecutive days.
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(Prescription 2) Chrysanthemum 100g, Moutan bark 250g, Angelica dahurica 250g, Ligusticum chuanxiong 250g.
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> Modifications: For severe headaches, add 250 grams of Asarum (place it in a small bag in a medicinal pillow; remove it when the pain subsides).
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For those with edema and facial flushing in the afternoon, the dosage of peony bark and chuanxiong can be increased to 375 grams.
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For those with weak stomach qi, if they find the smell of Angelica dahurica unpleasant, they can reduce the dosage by 125 grams.
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Usage: Put all the above herbs into a clean cloth bag and use it as a pillow when sleeping.
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> (Prescription 3) Astragalus membranaceus 30g, Epimedium brevicornu 10g, Morinda officinalis 10g, Polygonum multiflorum 30g, Rehmannia glutinosa 30g, Cinnamomum cassia 10g, Paeonia lactiflora 10g, Uncaria rhynchophylla 90g (added later), Angelica sinensis and Ligusticum chuanxiong 15g each, Tribulus terrestris and Tribulus terrestris 10g each, Os draconis and Ostrea gigas 30g each.
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> Modifications: For those with yang deficiency, add 10g of cinnamon; for those with yin deficiency, add 30g of scrophularia, 15-30g of peony bark, and 30g of rehmannia root; for those with phlegm-dampness, remove rehmannia root and add 10g of pinellia, 10g of tangerine peel, and 10g of acorus; for those with phlegm-fire, add 10g each of scutellaria and pinellia; for those with insomnia, add 15-30g of stir-fried jujube seed; for those with blood stasis, add 30g of salvia root and 10g of safflower.
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Usage: Decoction of the above-mentioned herbs, 1 dose per day, divided into 2 administrations.
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During treatment, all antihypertensive Western medicines and adjuvant drugs (including sedatives and tranquilizers) must be discontinued.
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> (Prescription 4) Use peanuts soaked in vinegar to treat high blood pressure.
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Soak peanuts in vinegar for 5-7 days, and take 15 peanuts each morning and evening to lower blood pressure. Once blood pressure is under control, the dosage can be reduced to every other day.
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> (Prescription 5) 15g each of Ganoderma lucidum, celery, Salvia miltiorrhiza, and Polygonum multiflorum, 10g each of Alisma plantago-aquatica and raw hawthorn.
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The powder was processed into powder, then encapsulated. Eight capsules were taken orally three times a day for three months. The total effective rate in treating 36 patients was 55.56%.