Elderly patients, who are treated for their high blood
pressure, have fewer heart attacks, strokes and congestive heart failure, than
the same age group with untreated hypertension.
The benefits of
treatment
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Research also reveals that the benefits of treating
hypertension are even greater for older patients than they are for younger
hypertensives. This is probably because the risk for cardiovascular
disease increases with age.
The numbers change
Although
reaching the age of 50 is certainly not seen as old, the significance of the
blood pressure readings may start to change. The systolic blood pressure,
the top number, is watched closely. For those under 50 years of age, the
systolic and diastolic numbers are of equal importance. A raised pulse pressure
is also a good predictor of cardiovascular events. Pulse pressure is the
difference between the systolic and diastolic number.
Isolated Systolic Hypertension (ISH)
ISH is a condition found in elderly patients and is due to age-related stiffening of the arteries. It is diagnosed when the systolic blood pressure is consistently above 160 mm Hg (high), and the diastolic below 90 mm Hg, (within normal limits). ISH is associated with increased stroke and heart problems, and should be treated.
White coat hypertension
This
condition is suprisingly common in older people, and must be distinguished from isolated systolic hypertension. In this case, blood pressure readings are only elevated if taken by a doctor, and normal elsewhere. 24-hour
monitoring is sometimes required to confirm the diagnosis.
Postural
Hypotension
Hypertension therapy in the elderly starts with lifestyle modification. If goal blood pressure cannot be achieved, pharmacological treatment is indicated. Some patients may experience a drop in pressure when changing position. Therefore, when monitoring older patients, the blood pressure should be repeated after standing for two minutes.
Essential Hypertension
Most
elderly patients have essential or primary hypertension, for which they may have
been treated since a younger age. Sometimes it is only diagnosed at an
older age. Essential hypertension has no obvious cause, but genetic and
environmental factors play a role. The same risk factors and lifestyle
modification are applicable to all age groups.
Lifestyle changes
The seemingly
inevitable elevation in blood pressure with age is much more pronounced in our
Western society. It is a reflection of lifestyle and diet. Changing
lifestyle habits are crucial to the elderly hypertensive. A low-salt diet
is especially important, as many patients seem to become more sensitive to salt
with age. Increased intake of potassium, the heart friendly mineral, must
be emphasized. Not only is the diet very often potassium deficient, but
many diuretics (water tablets) cause loss of this mineral. Exercise,
adapted to ability, must be regular and should include stretching for
flexibility.
Risk factors add up
The risk
for heart disease and stroke increases with age. Older patients are more
likely to have co-existing disease, like arteriosclerosis, that increases
cardiovascular risk. Arteriosclerosis is when fatty deposits are made in
the inner layer of blood vessels. This can clog it up and obstruct
flow. When this happens in the artery that supplies the kidney, it can
cause secondary hypertension. Arteriosclerosis also increases
cardiovascular incidents, like heart attacks and strokes. Elderly patients
with hypertension often already have target organ damage or clinical
cardiovascular disease. All these factors add up to increase total
risk. However, it also increases the benefit of treating the hypertension
in these patients.
Secondary prevention
If you have
had a stoke or heart attack before, you are at risk for having another. You may
have survived the first attack, but when discharged, many of the same risk
factors still exist. A management plan is needed to avert a
recurrence. This is called secondary prevention. These patients have
the highest risk of all, and many are elderly.
Common misconceptions
Many people
believe that older patients do not tolerate hypertension therapy, do not benefit
from it, and comply poorly. Research shows the response and compliance to
be at least as well as the younger group. The benefit, however, is much
higher in the older group.
Go slow
In older patients
with raised blood pressure, the aim will be to lower the pressure gradually over
a period of six months. Lifestyle and diet modification is the first line of
therapy. If drugs are needed, the type and dosage that cause the least
side effects will be used.
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