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High Blood Pressure In Elderly

What Is High Blood Pressure

Elder Care: Dealing With Low & High Blood Pressure

Blood pressure is recorded with 2 numbers. The systolic pressure is the force at which your heart pumps blood around your body.

The diastolic pressure is the resistance to the blood flow in the blood vessels.

They’re both measured in millimetres of mercury .

As a general guide:

  • high blood pressure is considered to be 140/90mmHg or higher
  • ideal blood pressure is usually considered to be between 90/60mmHg and 120/80mmHg

Blood pressure readings between 120/80mmHg and 140/90mmHg could mean you’re at risk of developing high blood pressure if you do not take steps to keep your blood pressure under control.

Everyone’s blood pressure will be slightly different. What’s considered low or high for you may be normal for someone else.

What Percentage Of Adults With Hypertension Had Their Blood Pressure Controlled

Among adults with hypertension during 20152016, 48.3% had controlled hypertension. The prevalence of controlled hypertension overall increased with age and was lower among those aged 1839 than among those aged 4059 and 60 and over . This pattern was similar for men. Among women with hypertension, the observed decline in control with age was not significant.

A higher percentage of women had controlled hypertension than men, both overall and among those aged 1839 .

Figure 3. Prevalence of controlled hypertension among adults with hypertension aged 18 and over, by sex and age: United States, 20152016

1Men significantly different from women in the same age group.2Significant increasing trend by age.NOTES: Estimates for age group 18 and over are age adjusted by the direct method using computed weights based on the subpopulation of persons with hypertension in the 20072008 National Health and Nutrition Examination Survey, using age groups 1839, 4059, and 60 and over. Crude estimates for age group 18 and over are 48.5%, total 45.2%, men and 51.6%, women. Access data table for Figure 3pdf icon.SOURCE: NCHS, National Health and Nutrition Examination Survey, 20152016.

Blood Pressure Targets Are Different For Very Old Adults

High blood pressure increases your chance of having a stroke. It also increases your chances of developing kidney damage, heart disease, memory problems including dementia, and many other serious health problems.

A persons target blood pressure should be specific to their individual needs. For example, the ideal blood pressure goal for very old people is not clear. This is because there have been few research studies about blood pressure that included this age group. High blood pressure can damage organs, such as kidneys. However, this occurs much more slowly or might not be obvious in very old people. In fact, it has been found that lowering blood pressure too much in very old people does not reduce their risk of dying and actually might be harmful. Frail older adults and those living in long-term care facilities may also have different targets. Overall goals of therapy and quality of life should be considered when determining their blood pressure targets.

In addition, some older adults may feel dizzy, fall, or pass out when they stand up. This happens when blood pressure is suddenly too low. This condition is known as postural or orthostatic hypotension. It poses a danger of fractures and other serious injuries. This is especially a concern in frail older people who often also have osteoporosis . They are more prone to a fracture if they fall.

Edema

Vascular Ulcers

You are at risk of developing vascular ulcers if you:

Heart Failure

Stroke

Transient Ischemic Attacks

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Colin And Dulcies Story

Dulcie is 102-years-old and lives with her son Colin, his wife Mary, and her Carer Sarah. She has dementia and has had full-time live-in care for over two years.

We talk to the family about the challenges of finding the right care solution for

a fiercely independent woman and how the positive benefits of live-in care with Sarah has transformed all of their lives.

Complications Of High Blood Pressure In The Elderly

Experts recommend lower blood pressure for older Americans

High blood pressure causes the heart to work harder. Therefore, arteries take a beating and the chances of stroke, heart attack and kidney problems increase. When high blood pressure is left undiagnosed and untreated, it can cause:

  • Enlargement of the heart, which may lead to heart failure.
  • Small bulges in blood vessels called aneurysms. Common locations for aneurysms are the main artery from the heart , arteries in the brain, legs, and intestines, and the artery leading to the spleen.
  • Blood vessels in the kidneys to narrow, which may cause kidney failure.
  • Hardening of the arteries, especially those in the heart, brain, kidneys and legs. This can lead to a heart attack, stroke, kidney failure or amputation of part of the leg.
  • Blood vessels in the eyes to burst or bleed, which may cause vision changes and can result in blindness.

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Key Terms About Blood Pressure And Hypertension:

  • Systolic blood pressure : the top number when BP is checked. This reflects the pressure in the arteries when the heart squeezes. Its by far the most important number to consider when it comes to older adults.
  • Diastolic blood pressure : the lower number when BP is checked. This reflects the pressure in the arteries when the heart relaxes.
  • Pulse: the heart rate. Automatic BP monitors report pulse along with BP. Doctors must evaluate a persons heart rate when considering a change in BP medication.
  • Hypertension: Usually defined as BP> 140/90, assuming the readings are taken in a doctors office. If only the systolic BP is high, this is called isolated systolic hypertension. This type of hypertension is very common in older adults, as aging is associated with both increases in systolic BP and decreases in diastolic BP.

What Are The Causes Of High Blood Pressure In The Elderly

High blood pressure patients are divided into two groups depending on whether or not the conditions cause is known. In a great majority of cases of hypertension in the elderly, causes are not known. Blood pressure simply rises as we age, and many confounding factors contribute to its development. This is called primary or essential hypertension.

If specific causes of high blood pressure in elderly adults are identifiedfor instance, kidney disease or a tumor in the adrenal glandthis is called secondary hypertension. However, this type of hypertension is much less common.

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Management Of Hypertension In The Elderly

We can treat moderately elevated blood pressure levels in the elderly by making simple lifestyle changes. This should be the first step before we resort to drugs. The following changes can be enough for some seniors to put their hypertension under control:

  • Adopting a healthy diet with a limited sodium intake
  • Losing excess body weight and maintaining a healthy BMI
  • Being physically active every day for at least 30 minutes
  • Quitting smoking and limiting alcohol consumption

What Is The Disease In The Elderly With High Blood Pressure With Heat In The Body

Isolated systolic hypertension – Most common hypertension among elderly

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Most people’s numbers are higher during the day and lower during sleep. Stress can boost blood pressure. So can eating a big meal.

Doctors have long been familiar with the phenomenon of “white coat hypertension” the tendency for some people’s blood pressure to shoot up when it’s tested in a doctor’s office. But the opposite can also happen. Blood pressure readings may be perfectly normal at the doctor’s office and elevated as soon as the person gets home, a condition called “masked hypertension.”

Do I really need medication?

Doctors need to tread carefully when treating older adults for hypertension, explains Logan. “Chronological age is less important than overall health,” he says. “I’d treat a very healthy 80-year-old as I would any hypertensive. But in many older people, the target needs to be carefully adjusted to avoid complications.”

High blood pressure increases the risk of heart attack and stroke, but very low blood pressure is dangerous, too, he points out. Abnormally low diastolic pressure, for instance, means not enough blood is flowing back to the heart. That can deprive the heart of oxygen, causing it to enlarge, and can rob the brain of blood.

Risks Of High Blood Pressure

If your blood pressure is too high, it puts extra strain on your blood vessels, heart and other organs, such as the brain, kidneys and eyes.

Persistent high blood pressure can increase your risk of a number of serious and potentially life-threatening health conditions, such as:

  • have a relative with high blood pressure
  • are of black African or black Caribbean descent
  • live in a deprived area

Making healthy lifestyle changes can sometimes help reduce your chances of getting high blood pressure and help lower your blood pressure if it’s already high.

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What Was The Prevalence Of Hypertension Among Adults During 20152016

Overall, the prevalence of hypertension among adults was 29.0%, and was similar among men and women .

The prevalence of hypertension increased with age, from 7.5% among adults aged 1839 to 33.2% among those aged 4059, and 63.1% among those aged 60 and over. A similar pattern was found among both men and women.

Men had a higher prevalence of hypertension than women among adults aged 1839 and 4059 , but men had a lower prevalence of hypertension than women among adults 60 and over .

Figure 1. Prevalence of hypertension among adults aged 18 and over, by sex and age: United States, 20152016

1Men significantly different from women in the same age group.2Significant increasing trend by age.NOTES: Estimates for age group 18 and over are age adjusted by the direct method to the 2000 U.S. Census population using age groups 1839, 4059, and 60 and over. Crude estimates for age group 18 and over are 32.1%, total 31.8%, men and 32.4%, women. Access data table for Figure 1pdf icon.SOURCE: NCHS, National Health and Nutrition Examination Survey, 20152016.

Special Considerations In The Elderly Population

High Blood Pressure Concerns for the Elderly

In the United States, the prevalence of elderly patients with adequately treated hypertension is quite low, estimated to be only 30% .9 Elderly patients are more prone to having isolated systolic hypertension systolic BP 140 mm Hg diastolic BP < 90 mm Hgwhich is likely a result of an increase in arterial stiffness from arteriosclerosis or impairment of nitric oxidemediated vasodilation.1012

ISH occurs in the majority of elderly patients with hypertension: more than 65% of hypertensive patients aged 60 years and more than 90% of those aged > 70 years have ISH.1,13 ISH is associated with a 2- to 4-fold increase in the risk for stroke, myocardial infarction , or cardiovascular mortality.14,15

Elderly persons are more sensitive to salt intake compared with a younger population, leading to higher systolic BP and higher pulse pressure when more salt is consumed by elderly individuals.16

Finally, elderly persons are at increased risk for developing orthostatic hypotension, a potentially dangerous drop in BP during positional change from supine to standing position, increasing the risk for syncope, falls, and injuries.

These characteristics must be taken into account and considered carefully when choosing an appropriate treatment protocol for this patient population.

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Isolated Systolic Hypertension In Elderly

Isolated systolic hypertension is an increase in systolic but not diastolic pressure. This is the most prevalent type of hypertension found in those aged above 50. The increase in blood pressure with age is mostly associated with structural changes in blood vessels, stiffness in arteries increases the blood pressure, and is associated with increased risk of cardiovascular diseases.

Isolated systolic hypertension is easily diagnosed in the elderly by checking their pulse pressure. Because, in this condition, due to decreased diastolic pressure and increased systolic pressure the pulse pressure is found to be increased.

All evidence indicates that treating the elderly hypertensive patient will reduce the risk of heart disease but it is not guaranteed in the very elderly.

How To Better Measure Blood Pressure

As you can imagine, a key component of optimizing BP management is to measure an older persons BP and pulse.

Measuring BP allows us to:

  • Diagnose people with hypertension,
  • Determine how severe it is ,
  • Evaluate how well people are responding to a treatment plan, whether that plan involves lifestyle changes or medication or both.

Measuring BP usually sounds straightforward.

People assume its just a matter of finding out what the BP was at the doctors office, or getting a reading from a home monitor, or maybe even a reading from a health fair or drugstore.

But in fact, research has shown that a single office-based BP reading often does not represent a persons usual BP. One study even found that the usual way of measuring BP misdiagnosed 24-32% of volunteers!

This is because people are often anxious when at the doctors office, which can temporarily raise BP. Studies estimate this white-coat hypertension affects 10-20% of people.

Furthermore, BP is constantly changing a bit, moment to moment. So experts agree that its much better to obtain several readings and average them, in order to properly assess a persons usual BP.

As you can imagine, this is not the way most peoples blood pressure is measured by their doctors.

So whats better?

Based on these facts, in 2008 the American Heart Association, American Society of Hypertension, and Preventive Cardiovascular Nurses Association issued a joint scientific statement.

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High Blood Pressure Is A Major Risk Factor For Heart Diseases And Stroke Especially In The Elderly Here’s Everything You Must Be Aware Of

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Is something as easy as climbing the stairs or carrying a bag of groceries makes the elderly in your house tire out, remember that its a reality for many people who have been diagnosed with heart-related ailments like high blood pressure . The major issue associated with high or low BP is it can go undetected for years.

In fact, one in eight people are said to suffer from high blood pressure in India, as per the National Health Survey, 2017. And now high BP is one of the leading causes of premature deaths and is directly responsible for about 50% strokes and 25% coronary heart diseases deaths in India.

When it comes to high blood pressure in the elderly, there are numerous questions that are still floating in our minds. This is why we got in touch with Dr. Anup Taksande, Consultant Interventional Cardiologist, Wockhardt Hospital, Mira Road, to answer them all for you!

Q. Why is high blood pressure called a silent killer for elderly patients?

Early detection of high blood pressure is the need of the hour. Often referred to as the silent killer, high blood pressure may show no symptoms initially. But it can put senior citizens at an increased risk for heart disease, heart failure, and stroke.

Q. What are the symptoms of high blood pressure in elderly people?
Q. Enumerate the major health risks that can get triggered due to high blood pressure?
Q. What are the major reasons that cause high blood pressure in elderly people?

Are There Any Medications That Can Help Treat High Blood Pressure Levels For The Elderly

Best Ways To Lower Your High Blood Pressure

Yes, many medications can help manage high blood pressure in seniors. Some common medications include: diuretics, ACE inhibitors, beta-blockers, and calcium channel blockers. Diuretics are used to help the body get rid of excess water and salt. ACE inhibitors help to relax blood vessels and reduce blood pressure. Beta-blockers work by slowing down the heart rate and reducing the force of heart contractions. Calcium channel blockers prevent calcium from entering into the muscles of the heart and blood vessels, which helps to relax the blood vessels and reduce blood pressure.

To track this medication you can use CareClinic app. It will help you to remember to take your medication, track your blood pressure, and provide information to your doctor. The App is free and available on iPhone and Android and can be downloaded by tapping the button at the top of the screen.

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Complications Of Hypertension In The Elderly

Untreated high blood pressure in older people causes some potentially life-threatening complications. While most of these problems wont present themselves until old age, there arent complications of hypertension only in elderly people. In fact, more and more young people have hypertension, so diagnosing and treating it on time is crucial for preventing the following problems:

Data Source And Methods

Data from the National Health and Nutrition Examination Surveys 19992016 were used for these analyses. Data from the most recent 2-year survey cycle, NHANES 20152016, were used to test differences between demographic subgroups. The precision and ability to detect differences in hypertension prevalence and control when a true difference does exist are lower with 2 years of data than when these estimates are based on 4 years of data, due to the smaller sample sizes. In testing for trends in hypertension prevalence and control, nine 2-year cycles were used.

NHANES is a cross-sectional survey designed to monitor the health and nutritional status of the civilian noninstitutionalized U.S. population using highly stratified, multistage probability designs . The survey consists of interviews conducted in participants homes and standardized health examinations conducted in mobile examination centers . Blood pressure was measured in the MEC by trained physicians using standard protocol on a total sample of 5,504 nonpregnant persons aged 18 and over.

During 20152016, non-Hispanic black, non-Hispanic Asian, and Hispanic persons, among other groups, were oversampled to obtain reliable estimates for these population subgroups. Specific race and Hispanic-origin estimates reflect persons reporting only one race those reporting more than one race are included in the total but not reported separately.

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