ISSN 2415-3060 (print), ISSN 2522-4972 (online)
  • 18 of 56
УЖМБС 2018, 3(6): 101–105
Clinical Medicine

Treatment of Isolated Systolic Hypertensive Disease without Complications in the Wards of the Psycho-Neurological Nursing Home

Gutareva N. V. 1, Yablochanska E. E. 1, Gutarev V. V. 2

Systolic blood pressure in the elderly should be reduced by 20 mm Hg, if initially it was within 160-180 mm Hg. If the initial systolic blood pressure exceeded 180 mm Hg, it should be equal 160 mm Hg. Blood pressure should be decreased by at least 10-15% from the initial and not more than 30%. The rate of blood pressure reduction is also important. The need for a sharp drop in blood pressure exists only when there is an emergency state of hypertension: symptoms of cardiac asthma, unstable angina, and hypertonic encephalopathy. In urgent cases, one should strive for a decrease in blood pressure for 24 hours. In other cases, there is usually no reason to take emergency actions. The results of the SHEP study (The Systolic Hypertension in the Elderly Program - the program of systolic hypertension in the elderly) are very important. It included 4736 patients over 60 years old (mean 72 years old) suffering from isolated systolic hypertension. Within 4.5 years, patients received placebo or thiazide diuretics at a lower dose (chlorthalidone 12.5 - 25 mg / day), adding to the latter, if necessary, atenolol. Active therapy has led to a decrease in the frequency of stroke by 25%, all cardiovascular complications by 32%. In the Swedish research (STOP-Hypertension) they studied the influence of diuretics and b-blockers on the course of hypertension in patients aged 70-84 years. While decreasing blood pressure on average of 20/8 mm Hg, they observed a decrease in the number of strokes by 47%, all cardiovascular complications by 40% and, most importantly, a significant decrease in overall mortality by 43%. It is noteworthy that the positive outcome did not depend on age and was observed even in 84-year-old patients. There was no difference in the rate of treatment discontinuation due to side effects in the groups of patients who received active treatment and placebo. This indicates a good effect of medication in elderly patients. Material and methods. There are 20 elderly wards with ischemic heart disease and hypertension and 15 elderly people with isolated hypertension as in-patients in the Slavic psycho-neurological nursing home. The first group (20 people) received an angiotransforming enzyme inhibitor in the form of baseline therapy at an average daily dose of 20 mg per day (enalapril). The second group (15 people) received an angioplasty enzyme inhibitor in combination with a diuretic enalozide (enalapril hydrochlorothiazide) at a daily dose of 25 mg per day. This is the maximum recommended dose for adults. We conducted observations on the effectiveness of the treatment during 1 year. Physical and instrumental research methods were used to control the action of the drugs: the calculation of the pulse and its evaluation (speed, duration, hardness, and rhythm), blood pressure measurements every morning and evening, registration of an ECG. Once a year, a comprehensive medical examination was carried out by specialists, one of which was an ophthalmologist, and a neuropathologist. Every three months our wards passed blood and urine tests, biochemical blood tests, and blood sugar. It is obvious that all patients had various degrees of cholesterol levels in blood. But we did not use in this complex of treatment the drugs of statins group because they are rather expensive. Results and discussion. During the year, we observed the following results: at the beginning of the course in the first group receiving enalapril, arterial pressure was recorded 170-180 / 90-100 mm Hg. Subsequently, when taking the drug, as expected, the pressure dropped to normal values to approximately 140-145 / 80-90 mm Hg. It took 7 to 10 days to stabilize the blood pressure. In 5 patients (25%) during the year, it was necessary to adjust the treatment of other drugs (amlodipine, magnesium sulfate), because under the influence of various factors, sometimes the pressure increased to critical values. In two patients (10%) there was a side effect of the drug - a dry cough, which led to the subsequent replacement of the usual enalapril to enalozide. One patient refused to take tableted antihypertensive drugs at all because of her main illness. Almost all patients of the second group felt practically good due to the action of the combined drug enalozide. There was no observed side effect of the drug. Stabilization of arterial pressure occurred more quickly than in the first group (up to 4-5 days). Additional dose adjustments and multiplicity of admission were not required.

Keywords: isolated systolic arterial hypertension, elderly patients, wards, arterial hypertension, combined drugs for the treatment of hypertension

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