Pressure in the elderly: what to do with low and high pressure in old age

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In the elderly, blood pressure (arterial and venous - systolic and diastolic) may decrease or increase several times a day. When the pressure and pulse of an elderly person deviates from normal values, dizziness occurs, weakness increases, and the state of health worsens.

You need to know what to do at home under low or high pressure. As well as normal pressure values ​​corresponding to age.

CONTENT

Pressure in the elderly: what should be normal

Arterial pressure is the process of applying blood pressure to the walls of blood vessels with a certain force. What can cause the deviation of the pressure index from the norm:

  1. Atherosclerotic changes - the elasticity of the walls of blood vessels decreases;
  2. Elasticity of the vascular walls - wear out and no longer withstand the pressure of the blood vessels, which causes increased pressure in the elderly or hypertension;
  3. Glands of internal secretion become ill;
  4. Sudden distension or constriction of blood vessels at the time of emotional stress, when violent emotions, such as fear or fury, involuntarily break out. During the hormonal reorganization, deformations of the vessels also occur;
  5. The properties of the heart shrink and distribute the correct movement of blood across all the vessels in each individual organism;
  6. Rheological properties of blood. When the blood becomes thick, it can collapse, its movement through the vessels becomes difficult, which can lead to diabetes mellitus and to blood pressure jumps. Dilute blood doctors sometimes advise leeches.

Pressure in the elderly: what is considered normal

The optimal pressure has a certain range of indicators, due to which the pressure of elderly people can vary quite significantly directly from age, sex, climatic conditions and nutrition.

In addition, there are a number of other factors that affect this conventional medical standard, which is considered to be a pressure of 120/80 mm Hg (Hg. c). This is the average indicator of a completely healthy person.

Approximate figures for upper and lower blood pressure in the elderly:

  1. Blood pressure norm: 110/70 (130/85).
  2. Normal pressure decreased: 100/60 (110/70).
  3. Hypotension, low blood pressure: less than 100/60.
  4. Normal pressure is increased: 130/85 (139/89).
  5. Hypertension, high blood pressure: more than 140/90.

Depending on the age category, blood pressure also has a conditional medical standard:

Age (number of years) The lower indicator (in mm. gt; art.) The upper indicator (in mm. gt; art.)
16-20 years old 100/70 120/80
20-40 years old 120/70 130/80
40-60 years old - not more than 140/90
more than 60 years - not more than 150/90

From the above indices of pressure, we can conclude that with age, the blood pressure figures increase, because the body changes: the contraction of the heart changes the rhythm, the vessels lose their elasticity and so on. Low pressure in an elderly person has to be raised, but high - to lower.

To reveal its norm for each individual, it is necessary to systematically measure the pressure with a special device - the tonometer, do not forget to record the indicators. If there are some symptoms, such as lethargy, fatigue, headaches or just a bad feeling, it is worthwhile, before calling a doctor or going to the district clinic, for several days to measure your blood pressure yourself at home. Knowing your norm, revealed by a regular measurement, you can easily determine whether it is worth taking drugs from the pressure of the elderly or you can still do without them.

Pressure in an elderly person, how to measure it correctly?

You can measure blood pressure in several ways. And a doctor who should correctly recommend pills for pressure for the elderly in order to improve their well-being, primarily relies on the readings of the instruments. Therefore, it is very important to do this correctly to accurately diagnose the disease and prescribe the appropriate treatment.

There are manual, automatic and electronic tonometers, which measure the pressure of a person.

In manual mode, a cuff is put on the arm above the elbow, the air is pumped through the pear with the other hand, and the needle will show the indication on a special device. This method requires some skills, but it is quite reliable and accurate in the testimony.

The automatic tonometer is the same way as manual, only the blood pressure readings can be seen on the electronic scoreboard, which additionally shows also the pulse.

The electronic tonometer pumps the air itself, it is enough to turn on the button on the electronic display. All indicators will be immediately visible on the monitor of the device.

The last two methods are very convenient, good and give accurate readings, but you need to closely monitor the battery and sometimes make preventive maintenance to be sure of the correct readings of the device. After all, based on figures and testimonies, the attending physician prescribes pills from pressure to the elderly and can be responsible for their actions.

When measuring blood pressure in humans, it is necessary to follow certain recommendations:

  1. Approximately half an hour before the start of the measurement, stop any physical work and workload, do not eat, drink coffee, do not smoke, try not to experience emotional distress;
  2. During the measurement period, use the device in a relaxed position, do not cross your legs;
  3. Keep static posture during measurement for accurate readings and not talk;
  4. The hand on which the cuff is worn should rest on a table or other surface and be at the chest level, with the back preferred to keep straight;
  5. It is necessary to carry out the measurement on two hands with a small time interval, for example, in 5-10 minutes.

If there is a deviation from the norms given in the tables above, it is necessary to check the device for measuring the pressure for breakage and to verify the correct indications of the apparatus. In case of confirmation of high or low blood pressure, consult a doctor immediately.

How to measure pressure by yourself with a mechanical tonometer

On the video channel "Mariamsecret". I show how it's possible to easily measure the pressure by yourself with a mechanical tonometer.

How to measure pressure without a tonometer?

Video channel "Witty." Apply this method or not - at your discretion, I can not guarantee its accuracy.

How correctly to measure arterial pressure by an electronic tonometer?

On the video channel "Med-Magazin".

Every second person has problems with blood pressure. Unfortunately, many people learn this sad fact, only when they turn to a doctor because of a serious ailment. Everyone needs timely monitoring and early diagnosis, in which the tonometer will help.

In order to obtain reliable information, you first need to understand how to correctly measure blood pressure to avoid typical errors. You need to remember 6 simple rules: in more detail in our video.

And at the same time, to eliminate this threat to the message to each of us, if we follow the simple rules that we dismantled in this clip. This will allow you to more accurately monitor the status of your BP, promptly and correctly start treatment to achieve the desired effect, without complications, expensive procedures and severe consequences.

Low pressure in the elderly, is it dangerous?

Constant low pressure in the elderly can cause considerable damage to the body, although people who suffer, on the contrary, increased pressure, do not see this as a complication. It causes chronic fatigue syndrome, the elderly person feels broken, not in the mood, he develops a state of depression in which he becomes unable to feel emotions and loses vitality.

Under hypotension, hypotension can cause nighttime sleep disturbances, and conversely, daytime sleepiness, distraction, memory impairment. Violated thermoregulation, there is sweating of the limbs of the body. Pain in the pericardial space appears, and the work of the gastrointestinal tract may also be disrupted.

All these health problems have their own causes, which could serve as stressful situations, heredity, malfunction of the immune system, various injuries and even improper nutrition.

Against the background of all these symptoms, the lowered pressure of an elderly person does not seem to be so painful, but hypotension should be treated, preferably in the event of the first complaints. It is necessary to undergo a test, in which the doctor will prescribe drugs for pressure from the elderly and recommend possible ways to increase the pressure. It is the doctor who will determine the reasons, tell and explain how to raise pressure to the elderly person for more active performance of simple domestic matters.

How to raise pressure to an elderly person at home

In the case where there is a decrease in pressure in an elderly person and it is necessary to take some urgent measures, then there are a number of ways that you can apply at home.

In plant products contain chemicals that can increase blood pressure.

Salt. Simple salt, if its crystals are placed under the tongue, can raise the pressure.

Coffee and cognac. A very effective and fast way is a cup of cooked coffee and a small dose of cognac. These means should not be abused, especially in the elderly, as both coffee and alcohol harm the stomach and liver. Very often the doctor prescribes a cure for elderly people to increase the pressure that contains caffeine.

Cinnamon. Ordinary cinnamon also has the ability to help with hypotension. From it prepare a decoction: 0.25 teaspoons of cinnamon powder is brewed for 200 g of water. The broth should be allowed to settle and add 1-2 spoons of honey. You can drink the broth chilled for half an hour before breakfast and half an hour before a night's sleep. This simple method is quite effective and it is not recommended to use it often, only in cases of strong and frequent increase in pressure.

Honey, breadandcinnamon. How to improve your health at home a little, what to do when low pressure is observed in an elderly person and lethargy occurs? You can eat a spoonful of honey with a small piece of bread sprinkled with cinnamon powder.

There are still ways recommended for hypotension:

Cold drinks. In hot climates and during periods of fever, drink cool water and other liquids if the pressure has decreased due to loss of moisture by the body;

Drops of tonic drugs. Well tincture of herbs that can be consumed in drops - 30-40 drops for half an hour before meals (ginseng, eleutherococcus, levzeya, licorice root, lemongrass, rhodiola rosea) are effective;

Massage. Do massage - ordinary and hydromassage, also rub palms and feet. To make acupressure it is possible to press cushions of fingers of fingers on the center of a nape and from above downwards to press on a carotid artery on a neck simultaneously on both parties.

It must be remembered that it is the physician who diagnoses primary or symptomatic (secondary) hypotension and determines the causes when low pressure in older people turns into a chronic disease and gives recommendations on what to do in this case.

There are general recommendations that will help to lead a more correct way of life:

  1. It is desirable to move more, engage in some kind of sport, aerobics, go to a fitness club, swimming pool. However, performing any exercises, it is worth keeping an eye on your condition. Exercises and sports help disperse stagnant blood and trigger a more coordinated work of the body.
  2. At the same time, when low pressure is observed in the elderly, and this is included in the category of the usual condition for a person, it is not recommended to jump out of bed in the mornings, and it is necessary to lie down for a while and allow the body to adapt to a new day. Sleep preferably about 8-9 hours.
  3. Drugs for elderly people are available for sale in pharmacies - Citramon, Ortho-taurine, Regulton, Saparal, Pyracetam, Cinnarizine. However, it is worth remembering that the right treatment can be prescribed only by a cardiologist or physician, especially when choosing the optimal dose for the use of the medicine.

If high blood pressure in an elderly person: what to do

When the blood pressure exceeds the norm of 140/90 mm Hg. This, however, has the scientific term hypertension. High blood pressure in the elderly has become a very progressive disease of our time, and the number of people suffering from this disease grows with geometric progression.

Hypertension is one of the most intractable diseases, and the reasons for its appearance can be quite a lot:

  1. Obesity and overweight.
  2. Drinking and smoking.
  3. Sedentary lifestyle.
  4. Eating large amounts of table salt in food.
  5. Hereditary diseases and predisposition.
  6. Diseases of the glands of internal secretion and organs.
  7. Stress, trauma and emotional stress.
  8. Various additional factors.

It is very important to find the cause, which resulted in increased pressure, and it is knowledge of this fact that will help keep the disease under control by hypertension. Under the guidance of the attending physician, all appropriate measures must be taken to prevent the risk of possible complications in the future.

When there is a high blood pressure in the elderly for a long time, it is surely preceded by such manifestations as dizziness, headache, migraine, sleep can also be disturbed and shortness of breath may appear.

For patients suffering from hypertension, changes in the retina of the eyeball are possible, which can lead to loss of vision. In addition, heart failure weakens the work of the main internal organ - the heart, and cardiovascular diseases occur. The brain does not receive sufficient blood supply and pathologies and disorders of the entire membrane system are possible.

The constant high blood pressure of an elderly person can cause a hypertensive crisis (GK). This is a very dangerous condition, when blood pressure suddenly and abruptly rises, renal and cerebral circulation is affected, which can lead to pulmonary edema, brain edema, stroke and myocardial infarction. At the same time, every elderly person will perceive elevated pressure in different ways.

Indications in the figures can vary greatly. One person will feel very bad at a pressure of 150/85 mm Hg. and in another organism at a pressure of 200/150 mm Hg. Art. will still function well.

Of course, the hypertensive crisis most often occurs at a later stage of hypertensive disease, however, sometimes even a completely healthy person can develop.

Some reasons that may serve to develop the hypertensive crisis:

  1. emotional stress and body overload,
  2. incorrect physical activity,
  3. climate change and a sharp change of weather,
  4. use of alcoholic beverages, smoking,
  5. consumption of large amounts of salt,
  6. incorrectly selected antihypertensive drugs,
  7. diseases of the endocrine system and internal organs.

Often, when a crisis course of hypertension occurs, when high blood pressure in an elderly person exceeds all permissible norms, he can experience panic attacks, feel a sharp headache, which is accompanied by nausea, vomiting, partial loss of vision.

Further, the development of GC leads to increased sweating, a person loses plenty of moisture, tremors of hands and feet appear, there is a chill or intense fever, the pulse becomes faster. Loss of consciousness is not uncommon in the development of hypertensive crisis, and sometimes a person can fall into a coma.

The provision of first aid is extremely necessary in this state. Since this happens suddenly, then, in addition to emergency care, a person will urgently need hospitalization and the first thing to do is take the necessary antihypertensive drug prescribed by the doctor in charge and call for emergency help.

If a person is shivering, he should be wrapped, laid on a flat surface, and raised his head. Do not give in to panic and provide the patient with the necessary peace, being next to him.

It is necessary to urgently reduce the pressure on the elderly person with a drug, so we will consider some antihypertensive drugs that reduce the risks of the disease.

How to reduce high blood pressure in the elderly

Remedies for the renin-angiotensin system

Renin is a substance present in the blood that, when interacted with angiotensinogen, another protein of the blood plasma, forms an inactive substance called angiotensin I. When contact occurs with angiotesin-converting enzyme (ACE), it passes into the active substance angiotensin II, which is the most strongly vasoconstrictor in the body.

Some types of drugs retain renin, which is represented by a single drug (aliskiren). Aliskiren is used in a complex in the treatment of hypertension and is not worth the small money. Other drugs inhibit ACE, others interfere with the activity of receptors on which angiotensin II acts.

Angiotensin converting enzyme (ACE) inhibitors

In active angiotensin II, this group of drugs does not allow the passage of angiotensin I. Then the substance angiotensin II decreases in blood, as a result of which the vessels begin to expand and the pressure in the elderly person finally falls.

Representatives (we quote the synonyms of preparations with identical chemical composition in parentheses):

  1. Captopril (kapoten) - dosage of 25 mg, 50 mg;
  2. Enalapril (renitek, berlipril, renipril, ednit, enap, enarenal, enam) - dosage is most often 5 mg, 10 mg, 20 mg;
  3. Perindopril (Prestarium A, perineva);
  4. Lizinopril (diroton, dapril, lysigamma, lisinotone) is usually a dosage of 5 mg, 10 mg, 20 mg;
  5. Ramipril (tritatse, amprilan, hartil, pyramidal) - more often in dosages of 2.5 mg, 5 mg, 10 mg;
  6. Fosinopril (focicard, monopril) - usually in a dosage of 10 mg, 20 mg;
  7. Zofenopril (Zocardis) - usually a dosage of 7.5 mg, 30 mg;
  8. Hinapril (acupro) - 10 mg;
  9. Trandolapril (gopten) - 2 mg.

Dosages of drugs are specially made for the convenience of treating high blood pressure at different stages.

Captopril (kapoten) is prescribed by a qualified physician when the pressure of the elderly increases sharply. It is used directly in hypertensive crises, since the action of the medicine is short.

Tablets from pressure to the elderly enalapril are classified as ACE blockers, they are recommended to be applied 2 times a day, since they do not cause a prolonged effect. Enalapril generics are also used in pharmacology, they are more affordable in the price range. They are produced by small pharmaceutical companies as analogues of preparations containing enalapril.

In any case, only after applying the drug within one or two weeks you can see the result of the use of drugs-ACE inhibitors.

The remaining drugs for pressure for the elderly, the list of which is given above, do not differ much. The only thing to remember is that there may be a dry cough as a side effect after some time after using ACE inhibitors. After a month of taking the medicine, this unpleasant consequence is usually observed. If the cough continues and does not go to "no", then the doctor will recommend changing the ACE inhibitor to the drug of another group.

Blockers (antagonists) of angiotensin receptors (sartans)

These medicines should not be evaluated for pressure from the elderly only after a certain time of admission, since their effects will not be immediately visible. They do not result in obvious results, they cost more, but the irritated throat caused by a dry cough will not be observed.

If you hold the Sartans, then the vessels will not shrink. Then angiotensin II will interact with angiotensin receptors, and the pressure will not increase.

Representatives:

  1. Irbesartan (aprovel) -150 mg, 300 mg;
  2. Lozartan (kozaar, lopaz, lorista, vazotens) - different dosages;
  3. Eprosartan (teveten) - 600 mg;
  4. Candesartan (atacand) 80 mg, 160 mg, 320 mg;
  5. Telmisartan (mycardis) - 40 mg, 80 mg;
  6. Olmesartan (cardosal) - 10 mg, 20 mg, 40 mg;
  7. Valsartan (diovan, valsakor, valz, nortivan, valsafors) - different dosages.

Calcium channel blockers

Calcium channel blockers reduce the load on the cardiovascular system. They are widely used in hypertension, arrhythmia, angina pectoris. When the vessels are dilated, the arteries stop resisting the movement of blood.

In another way they are called antagonists of calcium ions. The chemical compounds contained in these drugs block the channels through which calcium moves, which is attached to the cell membrane. So, the contractile protein ceases to form actomyosin, the vessels dilate, blood pressure drops, the pulse becomes less frequent (antiarrhythmic action).

Representatives:

  1. Nifedipine (adalate, cordaflex, kordafen, kordipin, corinfar, nifecard, phenygidine) - the dosage is basically 10 mg, 20 mg;
  2. Amlodipine (Norvasc, Normodipine, Tenox, Cordy corpus, Es Cordi Kor, Cardilopin, Calchek, Amlotop, Omelar Cardio, Amlovas) - dosage with mainly 5 mg, 10 mg;
  3. Felodipine (captive, felodip) - 2.5 mg, 5 mg, 10 mg;
  4. Nimodipine (nimotope) - 30 mg;
  5. Latsidipin (lacipil, sakur) - 2 mg, 4 mg;
  6. Lercanidipine (lercamen) - 20 mg.

All dihydropyridine calcium antagonists, in addition to nifedipine, have good productivity and last longer. There is a small side effect here - puffiness, which can occur when the drugs are started. Usually, puffiness disappears and falls off by the end of the week. If after seven days the puffiness does not decrease, it is desirable to replace the drug with another one.

Nifedipine, related to dihydropyridine derivatives, causes many side effects, for example, the pulse rate increases. Highly qualified cardiologists do not recommend the use of this drug in case of hypertensive crisis. To all other things, his action does not last long.

Pulse-mediating blockers should be used in arrhythmias:

  1. Verapamil (isoptin SR, verohalide EP) - 240 mg;
  2. Diltiazem (althiazem PP) - 180 mg.

Alpha-blockers

In the blood there is a movement of norepinephrine, and when alpha-adrenergic blockers come into contact with alpha-adrenergic receptors, it does not allow them to connect with norepinephrine, then the blood pressure begins to drop.

The representative used is doxazosin, which belongs to the alpha blocker (also cardura, toonocardin). It is available in dosages of 1 mg, 2 mg. The drug promotes the expansion of vessels that are located on the side and is used in long-term treatment, prevents the emergence of new seizures. In today's time, many drugs containing alpha-blockers are not released.

Beta-blockers

They are divided into different types (groups), since they act selectively on the subspecies of the receptors. Beta-blockers are actively used in the treatment of hypertension, when several types of diseases progress together. Renin-angiotensin ceases to be produced in the kidneys due to the action of drugs that interfere with the synthesis of prorenin. Beta-adrenoblockers delay some types of adrenoreceptors. Arterial pressure will decrease due to vasodilation.

With such diseases as diabetes mellitus or bronchial asthma, representatives of beta-blockers are contraindicated.

Representatives:

  1. Nebivolol (nebilet, binetol) - 5 mg;
  2. Betaxolol (lokren) - 20 mg;
  3. Metoprolol (betalk ZOK, aegilok retard, vasocardine retard, metokard retard) - various dosages;
  4. Bisoprolol (concor, coronale, biol, bisogamma, cordinorm, niperten, biprol, bidop, aritel) is usually a dosage of 5 mg, 10 mg;
  5. Carvedilol (carvetrend, coriol, tallitone, dilatrend, acridiol) - most often the dosage of 6.25 mg, 12.5 mg, 25 mg.

In hypertensive disease, anaprilin (obzidan), propranolol, atenolol not included in the group of these representatives are ineffective in use.

Diuretics (diuretics)

Diuretics, appointed by the doctor, remove excess water from the body, as well as chemical compounds, salts, sodium ions, accumulated in the vessels. In the work of the heart, potassium ions are needed, it needs to be preserved, and with the use of drugs it can be washed away. In combination with other diuretics, potassium is also taken.

Representatives:

  1. Indapamide (indap, ionic retard, arifon retard, acrypamide retard, ravel of CP, indapamide MV) is mainly a dosage of 1.5 mg.
  2. Triampur (a combined diuretic containing potassium-sparing triamterene and hydrochlorothiazide);
  3. Spironolactone (veroshpiron, aldactone);
  4. Hydrochlorothiazide (hypothiazide) - 25 mg, 100 mg, is a part of the combined preparations.

The specialist can prescribe diuretics in a complex reception together with antihypertensive drugs. Only the drug indapamide can be used outside the complex.

Emergency, only in case of emergency, you can use high-speed drugs, such as furosemide.

Neurotropic agents of central action and agents acting on the central nervous system

Often, stress is the cause of hypertension. At the same time, the central nervous system is highly excited, and various neurotropic drugs affect the central nervous system. Sleeping and soothing drugs and drugs reduce the activity of the vasomotor center in the brain.

Representatives:

  1. Moxonidine (physiotens, moxonitex, moxogamma) 0.2 mg, 0.4 mg;
  2. Rilmenidine (albarel (1 mg) - 1 mg;
  3. Methyldopa (dopegit) - 250 mg.

Previously, the drug clonidine was very widely used and very popular. Its effect is very strong, and the normal dose can be easily exceeded, which is fraught with coma. In our time, clonidine can be prescribed only by a doctor, and he is released on prescription.

Why do hypertension appoint to take several drugs simultaneously

As soon as a repetitive symptom arises, you should consult your doctor. He can prescribe one drug for use. As we have already said, it is necessary to first identify the cause of the disease.

In the case when the effect of one drug is ineffective or ineffective in full, the doctor recommends a set of drugs consisting of 2-3 to reduce pressure in the elderly person quickly. They will affect the various mechanisms discussed in this article and contribute to lowering blood pressure.

Drugs the doctor combines from different groups:

  1. ACE inhibitor / calcium channel blocker / beta-blocker;
  2. ACE inhibitor / diuretic;
  3. ACE inhibitor / calcium channel blocker;
  4. ACE inhibitor / calcium channel blocker / diuretic and other combinations;
  5. Angiotensin receptor blocker / diuretic;
  6. Angiotensin receptor blocker / calcium channel blocker / beta-blocker.

Drugs for hypertension and their complexes are prescribed only by a doctor!

What helps one person does not always fit the other, and sometimes the advice of other people is detrimental to health. Not knowing the hidden diseases of another person, you can severely damage the body. For example, in the diagnosis of diabetes mellitus there are prohibited combinations of drugs.

Beta-blockers / calcium channel blockers pulsuregatory, beta-blockers / preparations of central action and some other combinations in combinations are not suitable in the treatment of hypertension. It is worth remembering and referring to specialists for help.

Hypertension is a serious disease. Knowing all the reasons that a highly qualified cardiologist will pay attention to will help to successfully pass a course of treatment. It is important to remember that prescription drugs for the elderly, the list of which is present here, is indicative and does not serve as a guide to use.

Are there drugs in which substances from different groups are combined? Yes, hypertensive patients can be answered that combined drugs are used in medicine, they combine the components of different types of antihypertensive drugs.

It:

ACE inhibitor / diuretic:

  1. Enalapril / hydrochlorothiazide (co-renitek, enap NL, enap H, enap NL 20, renipril HT);
  2. Enalapril / indapamide (Duo Enzyme, Duo Fort Enzyme);
  3. Lizinopril / hydrochlorothiazide (isuzide, lisinoton, lithium H);
  4. Perindopril / indapamide (noliprel and noliprel forte);
  5. Hinapril / hydrochlorothiazide (acupuncture);
  6. Fosinopril / hydrochlorothiazide (focicard H).

Angiotensin receptor blocker / diuretic:

  1. Losartan / hydrochlorothiazide (gisaar, lopaz plus, lorist N, lorist ND);
  2. Eprosartan / hydrochlorothiazide (teveten plus);
  3. Valsartan / hydrochlorothiazide (co-diovan);
  4. Irbesartan / hydrochlorothiazide (co-flux);
  5. Candesartan / hydrochlorothiazide (atacand plus);
  6. Telmisartan / HCT (mycardis plus).

ACE inhibitor / calcium channel blocker:

  1. Trandolapril / verapamil (tar);
  2. Lizinopril / amlodipine (equator).

Angiotensin receptor blocker / calcium channel blocker:

  1. Valsartan / amlodipine (Exforge).

Calcium channel blocker dihydropyridine / beta-blocker:

  1. Felodipine / metoprolol (logimax).

Beta-blocker / diuretic (not possible with diabetes and obesity):

  1. Bisoprolol / hydrochlorothiazide (lodose, aritel plus).

Dosage and proper use can be recommended only by the attending physician, especially since all of the above preparations have a different dosage of a substance.

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