Skip to main content

Hypertension in Elderly - Causes and Management/Treatment

Hypertension in Elderly Management/Treatment

Hypertension in the elderly is a common problem.
An old patient may come to you with normal appearance and physical signs with slight symptoms of dizziness and the occasional headache.
but when you check his blood pressure, you find that it is higher (for example, > 170 mm of Hg).

Let’s take the following case as an example.

“A 76-year-old man visits his physician with the problem of occasional mild headache with no other noticeable symptom; he came to see the doctor because his wife compelled him to do so.

Past Medical History:
 
No history of heart disease, no stroke, no diabetes, no asthma, no TB.

Medications:
Not significant

Allergies:
 
No known drug allergies

Social History:
 
Business Man, smoked during his 20’s for 5 years, wine 2-3 times per week

Family History:
 
Father died of MI, Mother died of Stroke, one brother with coronary artery disease and a sister with stroke and hypertension

Exam
Sitting: BP=180/74 mm Hg; HR=78 bpm
One Minute Standing:
BP=165/72 mm Hg; HR=82 bpm
Three-minute standing
BP=172/70 mm Hg; HR=80 bpm
Repeat sitting BP 20 minutes later:
BP=162/66 mm Hg; HR= 82 bpm

ECG: left ventricular hypertrophy (LVH)

Lab: Electrolytes, BUN, Creatinine, glucose were normal. Urine: no microalbuminuria
Echo showing LVH and diastolic dysfunction

Most Common Cause Of Elderly Hypertension



Arterial stiffness is the most likely underlying mechanism for the elevation in blood pressure noted with ageing. Other mechanisms also contribute to elevated blood pressure such as endothelial dysfunction, salt handling difficulties, and decline in baroreceptor sensitivity, Kidney disease etc.

This is not orthostatic hypotension. His sit-to-stand blood pressure change is 8/4 mm Hg, which does not support the diagnosis of OH. The consensus is that a drop of 20 mm Hg in systolic blood pressure or a drop of 10 mm Hg or greater in diastolic blood pressure is needed for a diagnosis of Orthostatic hypotension.

Management

You advise the patient to measure his blood pressure at home and to return for a follow-up visit. He returns with home readings above 155/80 mm Hg and clinical sitting blood pressure of 180/70 mm Hg. His standing pressure was 170/65 mm Hg.

 
BP Classification
SBP
DBP
Life Style
Initial Drug Therapy
Normal
< 120
< 80
Encourage
-           
Prehypertensive
120 - 139
80 - 89
Yes
No antihypertensive Indicated
Stage 1 HTN
140 - 159
90 - 99
Yes
Thiazide Diuretic (may consider ACEI, ARB, BB, CCB or combinations)
Stage 2 HTN
> 100
> 160
Yes
Two drug combination for most ( usually thiazide diuretic and ACEI or ARB or BB or CCB
ACEI: ACE Inhibitors, ARB: Angiotensin receptor blockers,  BB: Beta blockers,   CCB: Calcium channel blockers



JNC7 recommends starting therapy with both pharmacological and non-pharmacological(eg. Lifestyle modifications) therapy if hypertension is confirmed.

Comments

Popular posts from this blog

Human Parasites, Types of Parasites, and Classification

Parasite: A parasite is a living organism which gets nutrition and protection from another organism where it lives. Parasites enter into the human body through mouth, skin and genitalia. In this article, we will generally discuss the types and classification of parasites. It is important from an academic point of view. Those parasites are harmful, which derives their nutrition and other benefits from the host and host get nothing in return but suffers from some injury. Types of Parasites Ecto-parasite: An ectoparasite lives outside on the surface of the body of the host. Endo-parasite: An endo-parasite lives inside the body of the host, it lives in the blood, tissues, body cavities, digestive tract or other organs. Temporary parasite: A temporary parasite visits its host for a short period of time. Permanent parasite: Permanent parasite lives its whole life in the host. Facultative parasite: A facultative parasite can live both independently and dependently. It lives in the

How to taper off, wean off beta blocker, atenolol, Propranolol, Metoprolol

Beta blockers include, atenolol (Tenormin), propranolol (Inderal ) and metoprolol (Lopressor) and are used to treat high blood pressure, certain cardiac problems, migraine and few other conditions. People usually take atenolol, propranolol or metoprolol for many years as a treatment of high blood pressure or after having an episode of heart attack . Sometimes, it becomes necessary to withdraw these beta blockers due to their potential side effects that trouble the patients or sometimes doctor wants to change the drug and shift the patient to some other anti-hypertensive medicine. No matter whatever the cause is, whenever, a patient who has been using a beta blocker for a long period of time, and he needs to be stopped from further usage of that beta blocker, must not stop taking it. One should taper off the dose of a beta blocker. Now a question arises how to wean off or taper off a beta blocker? The method of tapering off beta blocker varies from individual to individual. Allow you