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Hypertension in the elderly

Most people believe that high blood pressure is a disease of young people only- nothing can be further from the truth. As we age, our blood vessels start to stiffen, the body organs start to function poorly and several disorders start to appear- of which one of them is high blood pressure. In fact high blood pressure is quite common in elderly people and accounts for nearly 7-10 percent of visits to the primary care physician, just behind cold and sinus problems. These numbers are under estimates because high blood pressure has no symptoms and many elderly patients have no idea that they have this medical disorder.

The important thing to note is that treatment of high blood pressure in elderly people is associated with several benefits including lowered morbidity and mortality. Countless studies have shown that if high blood pressure in elderly is treated promptly, then the quality of life is improved and survival is prolonged.

High blood pressure is said to be present in the elderly when the blood pressure reading reaches 140/90 mmHg. Once high blood pressure develops in seniors it rarely disappears- it is for life. And while it may not have any symptoms, the condition still needs treatment. The good news is that there are many blood pressure medications that can be used to treat high blood pressure in elderly individuals.

What are symptoms of high blood pressure in elderly individual?

In general high blood pressure does not cause any symptoms. However, if the condition is neglected the individual may develop the following:

– Chest pain
– Blurred vision
– Headache
– Decreased urine production
– Shortness of breath
– Fatigue
– Generalized malaise
– Poor circulation in the legs
– Poor exercise endurance

In some cases, the high blood pressure can result in a stroke or a heart attack.

What causes hypertension in elderly?

The exact cause of high blood pressure in seniors is not known; in fact, in more than 95% of cases, no cause is ever found. This is what is known as essential or primary hypertension. In about 5% of elderly people the cause of high blood pressure may be related to problems with the kidney, adrenals, the peripheral vascular system or the heart. This is known as secondary hypertension but the treatment is the same as in primary hypertension.

What are complications of high blood pressure in the elderly?

If high blood pressure is not diagnosed or not treated in the elderly it can lead to the following complications:

– The heart gets bigger and will eventually fail leading to heart failure.

– The blood vessels in the abdomen, chest and brain can balloon and rupture. This is known as aneurysms.

– Blood vessels in the kidney become thick and narrow, eventually leading to kidney damage. When the kidneys fail to make urine, the individual will need dialysis.

– Blood vessels in the legs tend to become narrow and thick which leads to decreased blood supply to the foot and toes. This can lead to amputation of the leg or toes because of lack of blood circulation..

– Blood vessels in the eyes can bleed or burst which can result in vision loss.

How is diagnosis of hypertension made in elderly?

Before treatment can begin it is important to make sure that the elderly individual has high blood pressure. In most cases, the healthcare provider will measure the blood pressure at least three different times over a few weeks to confirm that the blood pressure is elevated. Plus, you will be asked to record your blood pressure at home and bring the numbers to the doctor. A diagnosis of hypertension is made if the repeated readings are 140/90 mmHg or higher. Measurement of blood pressure is done with a blood pressure gauge and does not take more than a few minutes.

How is high blood pressure treated in the elderly?

Even though in the past it was acceptable to monitor elderly with a blood pressure of 140/90 mmHg, today there is evidence that the blood pressure should remain below 120/80 mmHg even if the elderly patient has no symptoms. Most healthcare providers now start treatment if the blood pressure is above 120/80 mmHg.

Unlike young people, elderly with high blood pressure tend to respond to quite well to certain blood pressure medications. The healthcare provider will start you on the lowest dose of blood pressure medication and monitor you for response. The dose of the medication is gradually titrated depending on your response. Most elderly people require two more blood pressure medications.

What else can be done at home?

Once treatment of high blood pressure is started, at the same time you will be asked to:

– Eat a healthy diet, which means cutting down on salt
– Eating fruits, vegetables and low fat diary products.
– Staying active and performing some type of exercise regularly. Even walking is good as long as you do it for 45-60 minutes every day.
– Discontinue smoking
– Reducing intake of alcohol

What alternative treatments are available?

The treatment of high blood pressure in elderly people is for life. There are many effective medications to treat blood pressure and the type of medication will depend on your response. These medications work right away but have to be taken for life. Even though there are many health supplements and herbs touted to help lower blood pressure, it is important not to substitute them for your regular medications. Before you use any supplement, speak to your healthcare provider to make sure there are no interactions. Herbs and other supplements are only complimentary therapies.

Which elderly is at risk for high blood pressure?

Not all elderly people develop high blood pressure but there are some risk factors, which include:

– Being overweight
– Having a family history of high blood pressure
– Eating too much salt in the diet
– Consuming excess alcohol
– Not being active
– Taking certain medications
– Smoking
– Having emotional stress

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