“Hypertension medication”

At age 84 , our blood pressure goals do change. The side effect profile of many medications gets magnified by advanced age. To summarize the blood pressure goals based on the current cardiac guidelines, The ideal blood pressure is 120/80 or less. Pre-hypertension ( borderline high blood pressure) is 121-129. The cutoff is 130/80. Above that is stage 1 hypertension. 140/90 is the old cutoff . Now above 140/90 is stage 2,hypertension (old cutoff is 160/100). When we see patients, if either systolic (upper number) or diastolic (lower number) is above cutoff, then we round up. So 129/92 is Stage 2 hypertension (diastolic > 90). So we treat blood pressure aggressively. The cardiovascular treatment guidelines for hypertension were changed in 2017, because even mild longstanding hypertension leads :,to more myocardial infarctions (heart attacks); more congestive heart failure ; and more cerebral vascular accidents (strokes). Treatment starts with a long acting diuretic (chlorthalidone) and/or a calcium channel blocker (amlodipine). Its also reasonable to start with an angiotensin receptor blocker (losartan) or ARB. This is interchangeable with an angiotensin converting enzyme inhibitor ( lisinopril), particularly if they are diabetic or any form of heart failure. Beta blockers (metoprolol) are first line in patients with a history of coronary artery disease and MI. We often use 2 drugs at moderate doses (for the greater additive/ synergistic defects) ., rather than uptitrate mono therapy with