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When choosing a drug should be provided, which mechanism is dominant in the development of type 2 diabetes in this elderly patient and bear in mind the requirements for glucose-lowering drugs in this complex category of patients:

# The minimal risk of hypoglycemia
# Lack of hepatotoxicity
# Lack of nephrotoxicity
# No potential negative effects on the cardiovascular system
# The lack of interaction with other drugs
# Ease of use (1-2 times a day).

In fully meets these requirements of the drug sulfonylurea gliclazide group. Gliclazide refers to the selective sulfonylureas, only interacts with brand viagra specific receptors ATFzavisimyh bkletok potassium channels and does not interact with receptors on cardiomyocytes and endothelial cells. This feature allows you to avoid negative effects on the cardiovascular system, which is very important for elderly patients. The drug is slowly released into the bloodstream (the maximum drug concentration observed in the daytime, corresponding to postprandial hyperglycemia) reduces the activity of oxidative stress.

Antihypertensive therapy

Risk factors for rapid development and progression of atherosclerosis in patients with diabetes are not only hyperglycemia, but also to a greater degree of arterial hypertension (HT) and dyslipidaemia.

With age, there was a significant increase in the frequency of hypertension. At the age of 60 years, about 60% of men and 70% of women suffer from hypertension. At the age of 80 years, the prevalence of hypertension was 80%. Almost every second elderly patient has elevated blood pressure numbers at the time of detection of diabetes. AG is a major risk factor for cardiovascular complications of stroke, coronary heart disease, etc. The total mortality and mortality from cardiovascular disease in patients with hypertension diabetes increases 57 times.

The UKPDS conclusively brand name levitra showed the need for effective control of blood pressure in patients with type 2 diabetes and hypertension (regardless of age). Active antihypertensive therapy reduced the risk of micro-and macrovascular complications (37% and 34% respectively). Especially revealing reduction in the risk of stroke by 44%. Noted the reduction of total mortality and myocardial infarction, although these figures did not reach statistical significance.

For the elderly, in addition to increasing the prevalence of hypertension, is characterized by poor control of blood pressure, combination with other risk factors for cardiovascular events, some problems with the selection of antihypertensive therapy. These features are largely determined by the pathogenetic mechanisms of development and progression of hypertension in elderly patients.

Established that in the elderly increases the level of systolic blood pressure, whereas diastolic level is not changed, and even tends to decrease. About 80% of elderly patients with hypertension have isolated systolic hypertension (ISAH). Moreover, some patients are transformed sistolodiastolicheskoy AG, debuted in middle age, in ISAH. This process is due to age reduction in distensibility of large arteries that leads to a smaller change in volume of the aorta and large arteries in response to pressure change. Due to increased pulse wave velocity, which arises because of declining elasticity of the aorta, increasing systolic and diastolic blood pressure decreases.

Another pathogenetic feature of AD in the elderly increased sensitivity to sodium compared with patients of middle age. Therefore, in elderly patients with hypertension low salt diet and the appointment of diuretics leads to a more pronounced reduction in blood pressure.

In addition, elderly patients characterized by orthostatic hypotension (sudden drop in blood pressure when moving a patient from a prone position to sitting or standing), which leads to the development of reduced baroreflex activity.

Thus, the features of the pathogenetic mechanisms of development and progression of hypertension in elderly patients require a differentiated selection of antihypertensive therapy.

At what level of BP should begin treatment? In 1997, the VI Meeting of the Joint National Committee of the U.S. on diagnostics, prevention and treatment of hypertension recommended for patients with diabetes be considered a critical level of blood pressure for all age groups, systolic BP> 130 mm Hg and diastolic blood pressure> 85 mmHg, and for patients with renal insufficiency of 125 and 75 mm Hg respectively.

To what level of security reduces systolic and diastolic blood pressure? Completed in 1997 a major study © MUSIC µ, which included 19,000 patients (1500 diabetic patients with hypertension) showed that the optimal level of diastolic blood pressure, which indicated the smallest number of cardiovascular accidents, consistent 83 mm Hg Blood pressure reduction to this level was accompanied by a decrease in the risk of developing cardiovascular disease by almost 50%. Moreover, even more significant decrease in diastolic blood pressure in patients with coronary artery disease cialis without was not accompanied by increased mortality of these patients have not confirmed the presence of Jobraznoy relationship between low diastolic blood pressure and mortality from coronary heart disease.

In elderly patients with advanced atherosclerosis and the presence of stenosis of the carotid and intracranial arteries compliance with these recommendations, raises some concerns regarding possible violations of perfusion of cerebral vessels. Despite the lack of official data that blood pressure reduction to the level of 130/85 mm Hg and below, accompanied by an increased risk of cerebrovascular complications in these patients, decreased blood pressure in elderly people still needs to be gradual and cautious. In the appointment of antihypertensive therapy for older people should do the following:

# Selection of therapy based on the values of blood pressure when standing, sitting, lying;
# Begin therapy with low doses;
# Increase the doses gradually, with long intervals;
# Reach target BP levels extremely slowly (a few months - one year).

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