High Blood Pressure in Older People
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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 dont 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 (130139/8589 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 seniors 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:
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:
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.
DASH Diet for Hypertension: Lower Your Blood Pressure in 14 Days--Without Drugs by
Thomas J. Moore, M.D.
Guide to Lowering High Blood Pressure National Heart, Lung, and Blood Institute http://www.nhlbi.nih.gov/hbp/hbp/intro.htm
Available from ElderCare Online www.ec-online.net ©2002 Prism Innovations, Inc.