High Blood Pressure in Older People

by Richard O’Boyle, Publisher
More About Rich…

When people think of high blood pressure they often envision a stressed out rush hour commuter honking the horn, or a red-faced parent scolding a child. But high blood pressure, or hypertension, commonly has no symptoms, and most people don’t even know that they have it until it has damaged their heart or brain. It is aptly named “the silent killer.”

According to the National Heart, Lung, and Blood Institute, one in four adults, have a continuously elevated pressure of the blood moving through their arteries. For adults aged 70 and older, that number rises dramatically to two out of three. High blood pressure significantly increases your risk for getting heart disease and/or kidney disease, and for having a stroke. While there may be no symptoms, and people affected by high blood pressure may feel fine, some may experience dizziness, palpitations, sweating, and headaches.

Blood pressure is typically recorded as two numbers — the systolic pressure (as the heart beats) over the diastolic pressure (as the heart relaxes between beats). The Merck Manual on Medical Information defines high blood pressure as a systolic pressure at rest that averages 140 mm Hg or more, a diastolic pressure at rest that averages 90 mm Hg or more, or both. Usually both the systolic and the diastolic pressures are elevated. However, in the elderly, only the systolic pressure may be elevated, which nevertheless can cause medical problems down the road.

High blood pressure is common. More than 50 million American adults have high blood pressure. It is very common in African Americans, who may get it earlier in life and more often than Caucasians. Others at risk for developing high blood pressure are the overweight, those with a family history of high blood pressure, and those with high-normal blood pressure (130–139/85–89 mm Hg).

Special Factors for the Elderly

Many Americans tend to develop high blood pressure as they get older, but this is not a part of healthy aging. About 60% of all Americans age 60 and older have high blood pressure. Only a fraction of those who have high blood pressure actually know it and are actively treating it.

Only a few decades ago, the medical community treated the elderly differently when it came to high blood pressure. Since prescription drug interventions could prove risky, only those seniors with extremely high blood pressure were treated. According to the Society of Geriatric Cardiology, there are now numerous safe and effective blood pressure medications available. “It has been shown that the majority of older patients adhere and respond to treatment as well as or better than younger patients,” the Society notes.

Since the elderly have fluctuations in their blood pressure throughout the course of the day and may have adverse interactions with other medications, doctors should carefully monitor and adjust a senior’s medication. The Society of Geriatric Cardiology recommends that at least two or three blood pressure readings should be taken at different times to establish a diagnosis of hypertension.

The National High Blood Pressure Education Program Working Group emphasizes that blood pressure should be reduced "slowly and cautiously" in older patients. Lower initial doses of medications should generally be used, and increases in the doses of medications prescribed should likewise be made in smaller increments.  “The blood pressure in the elderly fluctuates more than in the young subject. The difficulty for the practitioner is to prescribe an antihypertensive drug for instance which will not lower the blood pressure too much in order to avoid the patient falling which could have dramatic consequences,” advises cardiologist Dr. Pierre Laurent, MD.

Dwight Makoff, M.D., Clinical Professor of Medicine at the UCLA School of Medicine, says, “It is important to measure the blood pressure in the elderly while they are standing in addition to while they are sitting or lying. You see, older patients may have a tendency to develop postural hypotension (excessively low blood pressure in the standing position). The postural hypotension can cause episodes of lightheadedness or falling. To remedy this situation, the doctor might recommend lower doses of anti-hypertensive medications.”

Prevention and Treatment

Although high blood pressure usually cannot be cured, in most cases it can be prevented and controlled. Nine out of ten cases of hypertension have no known cause. The remaining ten percent of cases are caused by kidney problems, hormonal disorders, drug interactions, or rare disorders such as lead poisoning. Your doctor will work with you to find the proper diagnosis and treatment plan. Treating and preventing high blood pressure rely on the adoption of a healthy lifestyle and the judicious use of anti-hypertensive medications.

The best way to prevent high blood pressure is by adopting a healthy lifestyle:

  • Following healthy eating patterns: emphasize fruits, vegetables, and low-fat dairy foods; eat foods low in saturated fat, total fat, and cholesterol; eat whole grains, poultry, fish, and nuts; reduce fats, red meats, sweets, and sugared beverages. (see The DASH Diet under “Sources” for more information)
  • Reducing salt and sodium in your diet: reduce salt intake to less than six grams (one teaspoon) per day from all sources.
  • Maintaining a healthy weight: since blood pressure rises as weight increases, reducing your weight can improve your hypertension, as well as reduce your risk for heart disease and diabetes.
  • Being physically active: even the lowest level of physical activity can have a positive impact on health and well-being.
  • Limiting alcohol intake: if you drink alcoholic beverages, have only a moderate amount — one drink a day for women; two drinks a day for men.
  • Quitting smoking: smoking injures blood vessels and speeds up the hardening of the arteries.

Medications

According to Dr. Makoff, treatment with medications that lower blood pressure reduce the risk for strokes and heart failure by 35%. Further, the incidence of other cardiovascular events (for example, heart attacks) can be reduced by 20%.

Elijah Saunders, M.D., Head of the Hypertension Section of the University of Maryland School of Medicine's Division of Cardiology, notes that many people shy away from taking the medications that could help them manage their blood pressure because they are concerned about their side effects. “Treatment methods, however, have improved over the years, and some of the old fears are unfounded,” he says.

"The way drugs are being used to control high blood pressure today is much more effective than in the past," Saunders says. "Doctors are using [a variety of new types of drugs] in ways that don't cause the sexual complications and other side effects of older therapies. Also, these new drugs only need to be taken once a day, instead of two or three times a day. This is a lot easier for patients."

According to the NHLBI, there are about nine categories of drugs used to treat hypertension. A doctor may prescribe a combination of two or three of these drugs to get the best result. Types of drugs used to treat hypertension:

  • Diuretics: Diuretics are sometimes called "water pills" because they work in the kidney and flush excess water and sodium from the body. This reduces the amount of fluid in the blood. There are different types of diuretics. They are often used with other high blood pressure drugs.
  • Beta Blockers: Beta blockers reduce nerve impulses to the heart and blood vessels. This makes the heart beat slower and with less force. Blood pressure drops and the heart works less hard.
  • Angiotensin converting enzyme (ACE) inhibitors: Angiotensin converting enzyme (ACE) inhibitors prevent the formation of a hormone called angiotensin II, which normally causes blood vessels to narrow. The ACE inhibitors cause the vessels to relax and blood pressure goes down.
  • Angiotensin Antagonists: Angiotensin antagonists are a new type of high blood pressure drug. They shield blood vessels from angiotensin II. As a result, the vessels become wider and blood pressure goes down.
  • Calcium Channel Blockers (CCBs): CCBs keep calcium from entering the muscle cells of the heart and blood vessels. This causes the blood vessels to relax and pressure goes down.
  • Alpha Blockers: Alpha blockers reduce nerve impulses to blood vessels, which allows blood to pass more easily, causing the blood pressure to go down. According to results from an NHLBI clinical study, an alpha blocker may not be the best choice for initial treatment for uncomplicated high blood pressure.
  • Alpha-beta blockers: Alpha-beta blockers work the same way as alpha blockers but also slow the heartbeat, as beta blockers do. As a result, less blood is pumped through the vessels and the blood pressure goes down.
  • Nervous system inhibitors: Nervous system inhibitors relax blood vessels by controlling nerve impulses. This causes the blood vessels to become wider and the blood pressure to go down.
  • Vasodilators: Vasodilators directly open blood vessels by relaxing the muscle in the vessel walls, causing the blood pressure to go down.
    (Source: National Heart, Lung, and Blood Institute)

The report of the 6th Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure has recommended that drug therapy be initiated with a diuretic, a beta blocker, a calcium channel clocker, or an ACE inhibitor, along with lifestyle changes. Ed G. Lakata, M.D., a physician and scientist, says, “Your physician selects the appropriate starter drug, a decision that may be influenced by your age and race and the presence of coexisting diseases or conditions, such as kidney disease, that may contraindicate a certain drug, or conversely indicate one drug over another. These are rough guidelines, and there are many additional factors that your doctor considers. If the first choice drug is ineffective, or causes intolerable side effects, another drug can be tried.”

When a doctor prescribes a regimen of drugs to treat hypertension, it is critical to follow it according to orders, and report any side effects immediately. In all cases, healthy lifestyle changes must accompany treatment with prescription drugs.

Related Articles:

- Tips on... Quitting Smoking
- Aging and Alcohol Abuse
- Renewal
- Walking Tips fro Seniors
- You and Your Doctor... It Takes Two to Tango
- Exercising Care
- Proper Nutrition 40+

Recommended Reading:

- The DASH Diet for Hypertension: Lower Your Blood Pressure in 14 Days--Without Drugs by Thomas J. Moore, M.D.
- The Mayo Clinic on High Blood Pressure by Sheldon G. Sheps, M.D.
- The Healing Power of Exercise: Your Guide to Preventing and Treating Diabetes, Depression, Heart Disease, High Blood Pressure, Arthritis, and More by Linn Goldberg, et al.
- High Blood Pressure: Practical, Medical, and Spiritual Guidelines for Daily Living With Hypertension (Hazelden Pocket Health Guide) by Mark Jenkins

Sources:

 - “Your Guide to Lowering High Blood Pressure” National Heart, Lung, and Blood Institute http://www.nhlbi.nih.gov/hbp/hbp/intro.htm
 - “Hypertension in the Elderly Deserves More Attention,” by Dwight Makoff, M.D., 6/27/02, http://www.focusonhighbloodpressure.com/script/main/art.asp?li=MNI&articlekey=18397
 - American Heart Association Patient Education Sheets http://www.americanheart.org/presenter.jhtml?identifier=83
 - The Merck Manual of Medical Information – Home Edition http://www.merck.com/pubs/mmanual_home/sec3/25.htm
 - “Treatment of High Blood Pressure in the Elderly: A Position Paper from the Society of Geriatric Cardiology,” http://www.sgcard.org/pp/treatment.html
 - High Blood Pressure Risk Assessment Tool, American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=3003499
 - “Healthy Eating” The DASH Diet (“Dietary Approaches to Stop Hypertension”) http://www.nhlbi.nih.gov/hbp/prevent/h_eating/h_eating.htm
 - Dr. Blood Pressure http://www.drbloodpressure.com/08-sitpart4.shtml
 - “High Blood Pressure: Tips to Stop the Silent Killer” by NoŽl Holton http://www.umm.edu/features/blood_pressure.htm
 - “What's Your Blood Pressure and How Do Blood Pressure Medications Work?” by Ed G. Lakata, M.D. http://www.healthandage.com/Home/gm=20!gsq=hypertension!gid2=1807

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