- "Very elderly" age is defined as over 70 or 80 years of age What are the nuances of treating hypertension in the very elderly age group? those who are over 70 or 80 years old... The point is not the age but the patient's condition. You see how active is the patient and what he is able to do. The main point that I find in the elderly - they are very sensitive to lowering blood pressure because the blood flow to the brain depends on the blood pressure and sometimes when you lower the blood pressure too much, you get less perfusion to the brain and it may cause some damage. #2 is that elderly patients are more susceptible to what we call orthostatic hypotension, that the blood pressure falls when they stand up. If you lower the blood pressure and you control it to 140 / 80 when the patient is sitting and then when patient stands up his blood pressure falls to 80 - 90 systolic, you may faint So the elderly are more friable and you have to be more careful. First, we agree that the blood pressure target may be a little bit higher than in the young subjects. we have to see the whole picture of the patient - it's not only the age but always the function and what additional diseases patient has, we have to start with lower doses and do the adjustment of the dose, to go gradually to prevent too much fall in blood pressure, which is even more risky because when you lower the blood pressure, you prevent in the long run stroke, congestive heart failure. But if the price that the patient pays, if his blood pressure falls immediately, and if he faints and breaks his leg - then the immediate risk is much higher than the benefit of long-term prevention of disease. So you have to balance and see what you have - what is the risk of acute side effects and cetera so in the elderly you go slowly until you reach the [blood pressure treatment] target and it may takes several weeks or even months, and unlike in the young subjects where you can go more aggressively in the adjustment of medications [and doses of hypertension medications]. Does that mean that it makes sense for elderly people, especially depending on their functional status, to measure arterial blood pressure when they're in a standing position? Definitely the answer is yes - you have to take the blood pressure when you are sitting and when you are standing, and if, when the first time that you do it, there is no difference [between sitting and standing blood pressure values] then you don't have to do it [again]. But when you start an anti-hypertension medications, and every time when you change the dose, you have to do it again because some of the side effects of the drugs are orthostatic hypotension - so if you start with normal response, but then when you give a new type of medication, then blood pressure might fall too much when you stand. So every time when you change the dose or the medication, you have to check the blood pressure while sitting and while standing. What would be the correct goal of blood pressure lowering in the standing position? - Blood pressure goal in standing position is the same as in the sitting position, which means not lower than 10 millimeter from the sitting position. If the [systolic] blood pressure decreased by 20 millimeters of mercury while moving from the sitting to the standing position, we call it orthostatic response and it may be a problem. So we measure the blood pressure - a difference of 5 to 10 mm of mercury is acceptable, if it's 20 millimeter of mercury in the systolic blood pressure or 10 millimeter of mercury in the diastolic blood pressure, this is orthostatic hypotension and we try to prevent it - because it may cause damage

- ...by adjusting doses of medications or changing medications - Right!