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Hypertension in elderly--an overview.

A Bhattacharyya, P Das

    Journal of the Indian Medical Association
    |February 1, 2000
    PubMed
    Summary
    This summary is machine-generated.

    Hypertension in the elderly presents unique challenges due to arterial stiffening. Effective management, particularly of systolic blood pressure, is crucial for reducing cardiovascular risks in this population.

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    Area of Science:

    • Gerontology
    • Cardiology
    • Internal Medicine

    Background:

    • Hypertension (HT) in the elderly is common and has distinct pathophysiological, clinical, and therapeutic implications.
    • Age-related arterial stiffening increases systolic blood pressure (SBP) and left ventricular (LV) mass, compromising cardiac output and renal blood flow.
    • Renin-angiotensin system and kidney involvement are minimal in elderly HT pathogenesis.

    Purpose of the Study:

    • To outline the diagnostic criteria and therapeutic strategies for hypertension in the elderly.
    • To highlight the specific challenges and considerations in managing hypertension in older adults.
    • To emphasize the importance of individualized treatment plans and monitoring for side effects.

    Main Methods:

    • Review of pathophysiological changes in elderly vasculature affecting blood pressure.

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  • Analysis of diagnostic criteria for hypertension, including isolated systolic hypertension (ISH).
  • Evaluation of therapeutic approaches, drug choices, and treatment goals for elderly patients with HT.

    • Main Results:

    • Diagnosis of HT is SBP > 140 mm Hg and/or DBP > 90 mm Hg, with ISH defined as SBP > 140 mm Hg and DBP < 90 mm Hg.
    • SBP elevation is more dangerous than DBP in the elderly, with significant risks of coronary artery disease (CAD) and cerebrovascular accident (CVA).
    • Therapeutic benefits are substantial, especially when SBP > 160 mm Hg, though diminishing after age 80.

    Conclusions:

    • Gradual, stepwise therapy is recommended, targeting BP below 140/90 mm Hg.
    • Diuretics (e.g., thiazide) are first-line agents, with ACE inhibitors and Calcium Entry Blockers (CEB) as alternatives for specific conditions.
    • Close monitoring for side effects due to altered physiology, pharmacokinetics, and drug interactions is essential in elderly patients.